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Informatics in Pharmacy

Disorders of Magnesium

August 12, 2018 By Dr. G, PharmD

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Hypomagnesemia:

  • Normal magnesium is 1.7-2.3 mg/dl.
  • Usually associated with ulcerative colitis, diarrhea, pancreatitis, laxative abuse, inadequate intake, alcohol use, diuretic use, often occurs concurrently with hypocalcemia and hypokalemia.
  • Symptoms include tetany, twitching, seizures, arrhythmias, hypertension, and sudden cardiac death.

Treatment:

  • Oral supplements
  • Symptomatic patients treated with 1-4 mg by IV infusion (1 g/hour to avoid hypotension and increased renal excreation).  Can be pushed in emergencies.
  • Reduce dose by half in renal insufficiency.

Hypermagnesemia:

  • Usually associated with CKD.
  • Symptoms include nausea, vomiting, bradycardia, hypotension, heart block, asystole, respiratory failure, and death.

Treatment:

  • Discontinue all magnesium-containing medications
  • Asymptomatic people with normal kidney function get 0.9% saline and loop diuretics.
  • Symptomatic patients get 100-200 mg of elemental calcium, usually calcium gluconate (see calcium section for gluconate vs chloride) IV over 5-10 minutes (the actions of magnesium in neuromuscular and cardiac function are antagonized by calcium).
  • May need hemodialysis in kidney disease.

Filed Under: Fluid, Electrolytes, & Nutrition

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020