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 accessOne-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 MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hypermagnesemia-induced cardiopulmonary arrest before induction of anesthesia for emergency cesarean section.J Clin Anesth. 2000; 12: 224-226
- Iatrogenic magnesium overdose: two case reports.J Emerg Med. 1996; 14: 187-191
- Iatrogenic magnesium overdose in a patient with suspected acute myocardial infarction.Am J Emerg Med. 1995; 13: 436-437
- Hypermagnesemia-induced fatality following epsom salt gargles(1).J Emerg Med. 2002; 22: 185-188
- Deliberate overdose with Epsom salts.BMJ Case Rep. 2009; 2009: 1-4
- Hypermagnesemia following an acute ingestion of Epsom salt in a patient with normal renal function.J Toxicol Clin Toxicol. 1996; 34: 735-739
- Acute hypermagnesemia after laxative use.Ann Emerg Med. 1996; 28: 552-555
- Fatal hypermagnesemia: an acute ingestion of Epsom salt in a patient with normal renal function.Caspian J Intern Med. 2018; 9: 413-415
- Epsom-salts poisoning and a review of magnesium-ion physiology.Anesthesiology. 1970; 32: 378-380
- Unsuspected morbid hypermagnesemia in elderly patients.Am J Nephrol. 1992; 12: 336-343
- Magnesium basics.Clin Kidney J. 2012; 5: i3-i14
- The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis.Acute Med Surg. 2018; 5: 222-229
- Severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a patient with renal failure and sigmoid volvulus.Case Rep Nephrol. 2014; 2014: 560746
- Magnesium metabolism and its disorders.Clin Biochem Rev. 2003; 24: 47-66
- Renal magnesium handling: new insights in understanding old problems.Kidney Int. 1997; 52: 1180-1195
- Renal control of calcium, phosphate, and magnesium homeostasis.Clin J Am Soc Nephrol. 2015; 10: 1257-1272
- Magnesium modulates parathyroid hormone secretion and upregulates parathyroid receptor expression at moderately low calcium concentration.Nephrol Dial Transplant. 2014; 29: 282-289
- Dialysate calcium levels: do they matter?.Blood Purif. 2019; 47: 230-235
Article info
Publication history
Published online: May 07, 2020
Accepted:
April 8,
2020
Received in revised form:
March 13,
2020
Received:
December 3,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
