Advertisement

Epsom Salt Ingestion Leading to Severe Hypermagnesemia Necessitating Dialysis

      Abstract

      Background

      Hypermagnesemia is an often overlooked electrolyte abnormality that has a myriad of presenting symptoms. It has been observed after both accidental and intentional ingestions of magnesium-containing compounds, and as in the case presented, Epsom salts, which are primarily magnesium sulfate.

      Case Report

      A 56-year-old man presented to the emergency department reporting weakness after an ingestion of Epsom salts used as a laxative and was found to be bradycardic and hypotensive. He subsequently developed altered mental status and respiratory depression necessitating intubation. His magnesium level was found to be > 3.91 mmol/L (> 9.5 mg/dL). He was given multiple doses of calcium gluconate and generous i.v. fluids with furosemide, with minimal improvement. However, his magnesium level corrected rapidly after initiation of dialysis, and 3 days later he was discharged home in good condition with normal neurologic function.

      Why Should an Emergency Physician Be Aware of This?

      Keeping a high level of suspicion for, and quickly recognizing, hypermagnesemia allows for prompt initiation of treatment, which can avoid significant hemodynamic or respiratory compromise. Mainstays of treatment are i.v. calcium and i.v. fluids. Loop diuretics may be given as an adjunct as well. Dialysis should be considered in cases of severe hypermagnesemia because it results in rapid correction of magnesium levels.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Morisaki H.
        • Yamamoto S.
        • Morita Y.
        • Kotake Y.
        • Ochiai R.
        • Takeda J.
        Hypermagnesemia-induced cardiopulmonary arrest before induction of anesthesia for emergency cesarean section.
        J Clin Anesth. 2000; 12: 224-226
        • Vissers R.J.
        • Purssell R.
        Iatrogenic magnesium overdose: two case reports.
        J Emerg Med. 1996; 14: 187-191
        • Frohna W.J.
        Iatrogenic magnesium overdose in a patient with suspected acute myocardial infarction.
        Am J Emerg Med. 1995; 13: 436-437
        • Birrer R.B.
        • Shallash A.J.
        • Totten V.
        Hypermagnesemia-induced fatality following epsom salt gargles(1).
        J Emerg Med. 2002; 22: 185-188
        • Milne H.
        • Dean P.
        • Hughes M.
        Deliberate overdose with Epsom salts.
        BMJ Case Rep. 2009; 2009: 1-4
        • Nordt S.P.
        • Williams S.R.
        • Turchen S.
        • Manoguerra A.
        • Smith D.
        • Clark R.F.
        Hypermagnesemia following an acute ingestion of Epsom salt in a patient with normal renal function.
        J Toxicol Clin Toxicol. 1996; 34: 735-739
        • Qureshi T.
        • Melonakos T.K.
        Acute hypermagnesemia after laxative use.
        Ann Emerg Med. 1996; 28: 552-555
        • Shoaib Khan M.
        • Zahid S.
        • Ishaq M.
        Fatal hypermagnesemia: an acute ingestion of Epsom salt in a patient with normal renal function.
        Caspian J Intern Med. 2018; 9: 413-415
        • Ditzler J.W.
        Epsom-salts poisoning and a review of magnesium-ion physiology.
        Anesthesiology. 1970; 32: 378-380
        • Clark B.A.
        • Brown R.S.
        Unsuspected morbid hypermagnesemia in elderly patients.
        Am J Nephrol. 1992; 12: 336-343
        • Jahnen-Dechent W.
        • Ketteler M.
        Magnesium basics.
        Clin Kidney J. 2012; 5: i3-i14
        • Nishikawa M.
        • Shimada N.
        • Kanzaki M.
        • et al.
        The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis.
        Acute Med Surg. 2018; 5: 222-229
        • Khairi T.
        • Amer S.
        • Spitalewitz S.
        • Alasadi L.
        Severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a patient with renal failure and sigmoid volvulus.
        Case Rep Nephrol. 2014; 2014: 560746
        • Swaminathan R.
        Magnesium metabolism and its disorders.
        Clin Biochem Rev. 2003; 24: 47-66
        • Quamme G.A.
        Renal magnesium handling: new insights in understanding old problems.
        Kidney Int. 1997; 52: 1180-1195
        • Blaine J.
        • Chonchol M.
        • Levi M.
        Renal control of calcium, phosphate, and magnesium homeostasis.
        Clin J Am Soc Nephrol. 2015; 10: 1257-1272
        • Rodríguez-ortiz M.E.
        • Canalejo A.
        • Herencia C.
        • et al.
        Magnesium modulates parathyroid hormone secretion and upregulates parathyroid receptor expression at moderately low calcium concentration.
        Nephrol Dial Transplant. 2014; 29: 282-289
        • Van der Sande F.M.
        • Ter meulen K.J.A.
        • Kotanko P.
        • Kooman J.P.
        Dialysate calcium levels: do they matter?.
        Blood Purif. 2019; 47: 230-235