From the Guidelines
To treat hypermagnesemia, administration of calcium, such as calcium chloride or calcium gluconate, may be considered, especially in cardiac arrest situations, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Treatment Approach
When managing hypermagnesemia, it's crucial to first identify and eliminate the source of excess magnesium. This includes discontinuing any magnesium-containing medications, antacids, or laxatives. Ensuring adequate hydration with intravenous normal saline is also vital to promote renal excretion of magnesium.
- For moderate hypermagnesemia, loop diuretics like furosemide can be administered to enhance magnesium excretion through the kidneys.
- In severe cases, particularly those with cardiac manifestations or magnesium levels >7 mg/dL, calcium gluconate 1-2 grams IV over 5-10 minutes can serve as a temporary physiological antagonist to magnesium's effects, as suggested by guidelines for managing cardiac arrest associated with hypermagnesemia 1.
Monitoring and Supportive Care
Monitoring cardiac function with ECG is essential, as hypermagnesemia can lead to bradycardia, hypotension, and cardiac arrest. Additionally, serum magnesium levels, renal function, and electrolytes should be closely monitored during treatment. Supportive care for respiratory depression may be necessary in severe cases, highlighting the importance of prompt and effective treatment for hypermagnesemia.
- In life-threatening situations or in patients with renal failure, hemodialysis is considered the most effective treatment to rapidly remove magnesium from the bloodstream.
- The use of calcium, as recommended by the American Heart Association guidelines 1, underscores the importance of addressing the cardiac effects of hypermagnesemia promptly and effectively.
From the Research
Treatment of Hypermagnesemia
The treatment of hypermagnesemia involves several strategies, including:
- Discontinuing magnesium-containing therapies 2
- Intravenous fluid therapy to help reduce magnesium levels 2, 3, 4
- Administration of calcium preparations, such as calcium gluconate, to counteract the effects of magnesium 3, 4, 5
- Use of loop diuretics to increase magnesium excretion 3, 4
- Dialysis in severe cases to rapidly correct magnesium levels 2, 4, 5
Management of Severe Hypermagnesemia
Severe hypermagnesemia requires prompt and aggressive treatment, including:
- Immediate discontinuation of magnesium-containing therapies
- Administration of high-volume intravenous fluids and calcium preparations
- Consideration of dialysis or continuous renal replacement therapy (CRRT) to rapidly correct magnesium levels 4, 5
Prevention of Hypermagnesemia
Prevention of hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements. This can be achieved by: