From the Guidelines
Hypermagnesemia treatment should involve immediate discontinuation of magnesium-containing medications and implementation of supportive measures, with calcium administration considered in severe cases, as per the 2010 American Heart Association guidelines 1. The treatment approach for hypermagnesemia is based on the severity of the condition.
- For mild cases (serum Mg 2.5-4 mEq/L), stopping magnesium intake and ensuring adequate hydration with normal saline may be sufficient.
- Moderate cases (4-6 mEq/L) require more aggressive IV fluid administration to enhance renal excretion.
- For severe hypermagnesemia (>6 mEq/L) with cardiac or neurological symptoms, intravenous calcium gluconate (10 mL of 10% solution over 10 minutes) serves as a physiological antagonist to magnesium's effects, as recommended by the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. In patients with renal failure, hemodialysis is the most effective treatment to rapidly remove excess magnesium.
- Loop diuretics like furosemide may be added to enhance magnesium excretion in patients with adequate renal function. Continuous cardiac monitoring is essential during treatment, especially in severe cases, as hypermagnesemia can cause dangerous arrhythmias and hypotension. The underlying cause of hypermagnesemia should also be identified and addressed to prevent recurrence, with particular attention to medication review, renal function assessment, and evaluation of endocrine disorders that might contribute to magnesium dysregulation, as suggested by the guidelines for management of cardiac arrest and severe cardiotoxicity due to hypermagnesemia 1.
From the Research
Hypermagnesium Treatment
- Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood 2.
- Clinical management of hypermagnesemia involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases 2.
- Preventing hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements 2.
Magnesium Intake and Hypermagnesemia
- Daily magnesium intake is the most important determinant of serum magnesium concentration in hemodialysis patients with chronic kidney disease (CKD) 3.
- Hypermagnesemia was observed in patients ingesting >281 mg of magnesium daily 3.
- There is a strong positive correlation between magnesium intake and serum concentration in hemodialysis patients with CKD 3.
Magnesium Supplementation
- Magnesium supplementation alone can improve chronic kidney disease-mineral bone disorder (CKD-MBD) by regulating serum calcium and parathyroid hormone metabolism and decreasing carotid intima-media thickness among hemodialysis patients 4.
- Magnesium supplementation had no significant effect on serum phosphate and C-reactive protein levels 4.
- Magnesium-containing drugs such as laxatives and cathartics can induce hypermagnesemia, particularly in those with impaired glomerular filtration and magnesium excretion 5.
Magnesium Metabolism in Hemodialysis Patients
- Lower serum magnesium levels are associated with an increased risk of all-cause and cardiovascular mortality among hemodialysis patients 6.
- Magnesium has been shown to inhibit the progression of vascular calcification both in vitro and in vivo 6.
- Magnesium may also be involved in the risk of fracture in the context of the bone-vascular axis 6.