From the Guidelines
To treat hypermagnesemia with a level of 2.6 mmol/L, discontinue the source of excess magnesium and ensure adequate hydration with intravenous normal saline, and consider administering calcium gluconate 10% solution (10-20 mL IV over 10 minutes) if symptomatic, as suggested by guidelines for managing special situations in cardiac arrest 1. When managing hypermagnesemia, it's crucial to identify and discontinue the source of excess magnesium, which may include magnesium-containing medications, laxatives, or antacids.
- Ensure adequate hydration with intravenous normal saline to promote renal excretion of magnesium.
- Loop diuretics such as furosemide 20-40 mg IV can enhance magnesium excretion when paired with IV fluids.
- Monitor electrolytes, especially calcium, as hypermagnesemia can cause hypocalcemia.
- For patients with renal insufficiency who cannot clear magnesium effectively, hemodialysis may be necessary.
- Calcium gluconate 10% solution (10-20 mL IV over 10 minutes) can temporarily antagonize magnesium's neuromuscular effects if symptomatic, as indicated in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Treatment should continue until magnesium levels normalize (normal range 0.7-1.1 mmol/L or 1.4-2.2 mEq/L), and it's essential to closely monitor vital signs, deep tendon reflexes, and cardiac function during treatment, as hypermagnesemia can cause hypotension, respiratory depression, and cardiac arrhythmias.
From the Research
Treatment of Hypermagnesemia
- The treatment of hypermagnesemia typically involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases 2.
- Supportive therapy for hypermagnesemia consists of administration of high-volume fluids, calcium preparation, diuretics, and, in severe cases, hemodialysis 3.
- In cases of severe hypermagnesemia, dialysis should be considered as it results in rapid correction of magnesium levels 4.
- Loop diuretics may be given as an adjunct to treatment, as seen in a case where a patient with severe hypermagnesemia was administered intravenous loop diuretics and calcium preparation in addition to high volumes of normal saline 3.
Management of Hypermagnesemia
- Prompt identification and management of hypermagnesemia are crucial to prevent complications, such as respiratory and cardiovascular negative outcomes, neuromuscular dysfunction, and coma 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.
- Healthcare providers should monitor serum magnesium concentration in patients at risk of hypermagnesemia and promptly intervene if the concentration exceeds the normal range 2.
Specific Considerations
- In patients with normal renal function, severe hypermagnesemia can improve with symptomatic treatment without hemodialysis 3.
- The daily intake of magnesium is an important determinant of serum magnesium concentration in hemodialysis patients with chronic kidney disease, and hypermagnesemia can be observed in patients ingesting more than 281 mg of magnesium daily 5.