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HYPERMAGNESEMIA

Definition
Magnesium is a mineral the body uses as an electrolyte,
meaning it carries electric charges around the body when
dissolved in the blood.
Hypermagnesemia refers to a high level of magnesium
in the blood. It is rare and is usually the result of renal
failure or poor kidney function.
Notes: Magnesium has a role in bone health,
cardiovascular function, and neurotransmission, among
other functions. Most magnesium is stored in the bones.
Causes/Risk Factors

 Renal Failure (kidneys unable to efficiently PATHOPHYSIOLOGY


excrete magnesium) Medication use, renal function, dietary intake
 Patients receiving magnesium to control seizures (Consuming an excessive amount of magnesium-rich
(Magnesium is a potential modulator of seizure foods or supplements can overwhelm the body's ability
activity, Low levels of the minerals sodium, to excrete magnesium) and alcohol abuse.
calcium, and magnesium can alter the electrical
activity of brain cells and cause seizures.) Age (older adults), genetics, underlying medical
 Excessive intake of antacids, laxatives, TPN conditions (DKA, renal failure), and pregnancy
(ingesting larger amounts of magnesium than the
kidneys are able to excrete (supplements or
medication e.g. magnesium hydroxide- often
used for heartburn or constipation)
This is where the problem starts pag may renal failure
 Untreated diabetic ketoacidosis
ang tao. Remember, that our renal or kidneys main
 2(When someone consumes more alcohol than function is to filter out and metabolizes electrolytes gina
recommended regularly, their bodily stores of control ang Ph Levels.
magnesium slowly become depleted.)
Approximately 10% of filtered magnesium is absorbed
in the proximal tubule, whereas most of the filtered
magnesium gets passively reabsorbed in the ascending
limb of the loop of Henle. Consequently, if may renal
dysfunction, the solutes become less concentrated then it
accumulates in the bloodstream that will lead to elevated
blood levels of magnesium. Pag nag accumulate na doon
ang magnesium, mahihirapan yung kidney na ma excrete
yung excess na magnesium. Bale, ma sstore na yung
magnesium. Some symptoms may occur like muscle
weakness, lethargy-------- and that will lead to
HYPERMAGNESEMIA
Clinical Manifestations Diagnostic Examinations
 Urinalysis- This test may be used to
investigate causes of abnormal serum
magnesium levels. It may also be used to
assess risk for renal stone formation and to
evaluate for magnesium deficiency or
excess.
 Serum magnesium test- primary test used to
diagnose hypermagnesemia. A blood sample
is drawn from a vein, and the serum
magnesium concentration is measured. The
reference range for normal serum
magnesium levels is typically around 1.7 to
2.2 milligrams per deciliter (mg/dL) or 0.7
to 0.9 millimoles per liter (mmol/L).
 Nausea  Arterial blood gas
 Drowsiness  Basic metabolic panel (specifically GFR,
 Tingling sensation in the face (facial creatinine, BUN, Glucose, urine specific gravity)
paresthesia)  ECG (prolonged P-R and QRS interval
 Progressive loss of deep tendon reflexes (earliest  Evaluation of urine output (renal function)
sign)  Blood tests
 Coma
 Muscular paralysis
 Respiratory failure Lab Values
 Cardiac arrest Above 2.5 mg/dl
Most of the time it’s asymptomatic especially if mild. 2.5-7 mg/dl is mild
 Mild hypermagnesemia (less than 7 mg/dL) - 7-12 mg/dl is moderate
Asymptomatic or paucisymptomatic (presenting
few symptoms): weakness, nausea, dizziness, 12-15 mg/dl is severe
and confusion Over 15 mg/dl is fatal (cardiac arrest, coma, death)
 Moderate hypermagnesemia (7 to 12 mg/dL) -
Decreased reflexes, worsening of the
confusional state and sleepiness, bladder
paralysis, flushing, headache, and constipation. Notes: Hypermagnesemia is diagnosed using a blood
A slight reduction in blood pressure, test. The level of magnesium found in the blood
bradycardia, and blurred vision caused by indicates the severity of the condition.
diminished accommodation and convergence are
usually present. A normal level of magnesium is between 1.7 and 2.3
 Severe hypermagnesemia (greater than 12 mg/dL. Anything above this and up to around 7 mg/dL
mg/dL) - Muscle flaccid paralysis (inability to can cause mild symptoms, including flushing, nausea,
contract the muscles manifesting itself in and headache.
such ways as an inability to close the eye, or Magnesium levels between 7 and 12 mg/dL can impact
lift the corner of the mouth), decreased the heart and lungs, and levels in the upper end of this
breathing rate, more evident hypotension and range may cause extreme fatigue and low blood
bradycardia, prolongation of the P-R interval, pressure.
atrioventricular block, and lethargy are
common. Coma and cardiorespiratory arrest can Serum magnesium concentrations > 2.6 mg/dL (> 1.05
occur for higher values (over 15 mg/dL). mmol/L)
At serum magnesium concentrations of 6 to 12 mg/dL Administration of IV furosemide can increase
(2.5 to 5 mmol/L), the ECG shows prolongation of the magnesium excretion when renal function is adequate;
PR interval, widening of the QRS complex, and volume status should be maintained.
increased T-wave amplitude.
Hemodialysis is necessary treatment option for severe
Deep tendon reflexes disappear as the serum magnesium hypermagnesemia when the condition is life-threatening
concentration approaches 12 mg/dL (5.0 mmol/L); or not responding to other measures.
hypotension, respiratory depression, and narcosis
develop with increasing hypermagnesemia. Cardiac
arrest may occur when blood magnesium concentration
is > 15 mg/dL (6.0 to 7.5 mmol/L).
Nursing Management

Medical Management  Monitor cardiac, respiratory, neuro


system, renal status. Put patient on
cardiac monitor (watch for EKG changes)
The first step in treating hypermagnesemia is identifying (Ensure safety due to lethargic/drowsiness (Ensure a safe
and stopping the source of extra magnesium. environment to prevent falls and injury due to muscle
weakness and altered mental status.
Use bed alarms or assistive devices as needed.)
An intravenous (IV) calcium supply is then used to
reduce symptoms such as impaired breathing, irregular  Prevention:
heartbeat, and hypotension, as well as the neurological
1. Avoid giving Magnesium containing
impact. antacids/laxative to patients with renal
failure

Intravenous calcium, diuretics, or water pills may also be 2. Assess for hypermagnesemia during IV
infusions of magnesium sulfate for
used to help the body get rid of excess magnesium. hypomagnesemia (sign and symptom
would be diminished/absent deep tendon
reflexes)
People with renal dysfunction or those who have had a
3. Withhold foods high in magnesium, such
severe magnesium overdose may require dialysis if they as:
are experiencing kidney failure, or if magnesium levels Remember:
are still rising after treatment. “Always Get Plenty Of Foods Containing Large Numbe
rs of Magnesium”
 Calcium gluconate  Avocado
o Calcium and magnesium compete for
binding sites  Green leafy vegetables
o Reserved for severe, symptomatic  Peanut Butter, potatoes, pork
hypermagnesemia
 Oatmeal
 Loop diuretics increases the urinary excretion of
magnesium  Fish (canned white tuna/mackerel)
 Cauliflower, chocolate (dark)
Calcium gluconate may temporarily reverse many of the  Legumes
magnesium-induced changes, including respiratory
 Nuts
depression.
 Oranges
 Milk
 Administer diuretics that waste healthcare professional for proper evaluation and
magnesium (if patient is not in renal management.
failure) such as Loop and Thiazide
diuretics
 Patient in renal failure patient prep for MODIFIABLE FACTORS
dialysis
Hypermagnesemia is a condition characterized by high
 IV calcium may be order to reverse side levels of magnesium in the blood. It can be caused by a
effects of Magnesium (watch IV for variety of factors, some of which are modifiable.
infiltration) Modifiable factors that can contribute to
hypermagnesemia include:

CAUSES/RISK FACTORS
Hypermagnesemia is a condition characterized by 1. Medication Use: Certain medications, such as
abnormally high levels of magnesium in the blood. It can laxatives or antacids containing magnesium, can lead to
occur due to a variety of causes and risk factors, hypermagnesemia when used in excessive amounts or
including: for extended periods. Modifying the use of these
medications can help prevent hypermagnesemia.
2. Renal Function: Kidney function plays a crucial role
1. **Renal Insufficiency:** Impaired kidney function is in regulating magnesium levels in the body. Conditions
one of the most common causes of hypermagnesemia. that affect renal function, such as kidney disease, may
The kidneys play a crucial role in regulating magnesium lead to impaired magnesium excretion. Managing and
levels in the body, and when they are not functioning treating kidney disease can help prevent
properly, magnesium excretion is reduced. hypermagnesemia.
3. Dietary Intake: High dietary intake of magnesium-
rich foods or supplements can contribute to
2. **Excessive Magnesium Intake:** This can occur
hypermagnesemia. Modifying your diet and reducing
through dietary sources, supplements, or medications.
magnesium intake can help manage magnesium levels in
Consuming a diet high in magnesium-rich foods or
the body.
taking magnesium-containing supplements in excess can
lead to elevated magnesium levels. 4. Alcohol Abuse: Chronic alcohol abuse can lead to
electrolyte imbalances, including hypermagnesemia.
Reducing or eliminating alcohol consumption can help
3. **Medications:** Some medications can contribute mitigate this risk.
to hypermagnesemia, particularly if used inappropriately
or excessively. Examples include antacids, laxatives, and
certain magnesium-based cathartics. NON-MODIFIABLE FACTORS
Non-modifiable factors are those that cannot be changed
or influenced by lifestyle or medical interventions. When
8. **Alcoholism:** Chronic alcohol abuse can result in
it comes to hypermagnesemia, several non-modifiable
electrolyte imbalances, including hypermagnesemia.
factors may increase the risk of developing this
condition. These factors include:
It's essential to recognize the causes and risk factors of
hypermagnesemia, as prompt identification and
1. **Age:** While age itself is non-modifiable, older
treatment are crucial to prevent complications. The
adults are more susceptible to hypermagnesemia due to
treatment of hypermagnesemia often involves addressing
age-related changes in kidney function and increased
the underlying cause and, in severe cases, medical
medication use.
interventions like dialysis may be necessary to lower
magnesium levels rapidly. If you suspect you have 2. **Genetics:** Some rare genetic disorders or
hypermagnesemia or are at risk for it, consult a mutations can affect the body's ability to regulate
magnesium levels, leading to a predisposition to
hypermagnesemia. These genetic factors are not
alterable.

3. **Underlying Medical Conditions:** Certain


chronic medical conditions, such as
hyperparathyroidism, may increase the risk of
hypermagnesemia. These conditions are typically non-
modifiable, although they can be managed or treated.
4. **Pregnancy:** Pregnant women may be at a higher
risk for hypermagnesemia due to the physiological
changes that occur during pregnancy. However, this is
generally not modifiable.

It's essential to be aware of these non-modifiable risk


factors, as they may indicate an increased susceptibility
to hypermagnesemia. Individuals with such risk factors
should work closely with healthcare professionals to
monitor and manage their magnesium levels and take
appropriate precautions to prevent complications
associated with hypermagnesemia.

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