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Hypermagnia
Last reviewed: 23.04.2024
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Hypermagnesium is a condition when magnesium is elevated more than 2.1 meq / l (> 1.05 mmol / l). The main cause is renal failure.
Symptoms of hypermagnesium include hypotension, respiratory depression and cardiac arrest. Diagnosis is based on the determination of the serum magnesium level. Treatment includes intravenous administration of calcium glucanate and, possibly, furosemide; in severe cases, the use of hemodialysis can be effective.
Pathogenesis
Magnesium is the fourth most common cation in the body. An adult weighing 70 kg contains about 2000 meq of magnesium. About 50% is sequestered in bone tissue and does not participate in the exchange with other spaces. In EWC there is only 1% of the total magnesium content in the body. The rest is in the intracellular space. The normal concentration of magnesium is 1.4-2.1 meq / l (0.7-1.05 mmol / l).
Maintaining the magnesium concentration in the plasma depends on the intake with food and the effective renal and intestinal delay. 7 days after the onset of a diet with magnesium restriction, renal and LC excretion of magnesium fall by 1 meq / day (0.5 mmol / L per day).
About 70% of the magnesium of the plasma undergoes renal filtration; the remainder is associated with proteins. Binding to proteins is pH-dependent. The concentration of magnesium in the plasma and the total content in the body are not closely related. However, severe hypomagnesemia may reflect a decrease in magnesium stores in the body.
Magnesium activates many enzymes, some depend on it. Magnesium is necessary for all enzymatic processes, including ATP, and for many enzymes involved in the exchange of nucleic acids. Magnesium is necessary for cofactor activity of thiamine pyrophosphate and stabilizes the structure of DNA and RNA macromolecules. Magnesium is also associated with the metabolism of calcium and potassium, but the mechanism is not fully understood.
Hypermagnesemia is more common in patients with renal insufficiency after taking medications containing magnesium, such as antacids or laxatives.
Symptoms of the hypermagnes
When the concentration of magnesium in the plasma is 5-10 meq / l (2.5-5 mmol / l), the ECG prolongs the PR interval, the QRS complex increases and the amplitude of the T wave increases. Deep tendon reflexes disappear when the magnesium concentration in the plasma increases to 10 meq / l (5.0 mmol / l); with progressive hypermagnesemia, hypotension, respiratory depression and anesthesia develop. Cardiac arrest can be observed at a magnesium level of blood above 12-15 meq / l (6-7.5 mmol / l).
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Treatment of the hypermagnes
Heavy hypermagneemia is treated by such methods as: support of circulation and respiration with intravenous injection of 10-20 ml of calcium gluconate. Calcium gluconate can reverse the many changes induced by magnesium, including respiratory depression. Administration of furosemide intravenously can increase magnesium excretion if the kidney function is normal. With severe hypermagnesemia, hemodialysis can be effective, since a relatively large part (about 70%) of blood magnesium does not have protein binding and therefore is ultrafiltered. In the case of hemodynamic failure and inappropriate hemodialysis, a possible option is peritoneal dialysis.