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Questions and Answers
What is the typical range for magnesium levels in mEq/L?
What is the typical range for magnesium levels in mEq/L?
What are common causes of hypermagnesemia in non-pregnant patients?
What are common causes of hypermagnesemia in non-pregnant patients?
What should be administered intravenously to prevent complications from hypermagnesemia?
What should be administered intravenously to prevent complications from hypermagnesemia?
What is the panic threshold level for hypermagnesemia that raises concern for cardiac symptoms?
What is the panic threshold level for hypermagnesemia that raises concern for cardiac symptoms?
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Which treatment is NOT effective for eliminating excess magnesium?
Which treatment is NOT effective for eliminating excess magnesium?
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What is a common symptom of hypomagnesemia in patients?
What is a common symptom of hypomagnesemia in patients?
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In cases of hypermagnesemia, what serious cardiovascular symptoms might occur?
In cases of hypermagnesemia, what serious cardiovascular symptoms might occur?
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What should be avoided when treating hypermagnesemia in anuric patients?
What should be avoided when treating hypermagnesemia in anuric patients?
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Study Notes
Magnesium Levels
- Typical range: 1.4-1.7 mEq/L, 1.7-2.3 mg/dL, 0.7-0.95 mmol/L.
- Note: Institutional ranges may differ slightly.
- High alert medication: Magnesium sulfate.
Hypermagnesemia
- High panic threshold, but fairly common in labor patients with pre-eclampsia.
- Should not be ignored in non-pregnant patients due to decreased renal excretion.
- Worry about cardiac symptoms (QT interval prolongation) when Mg levels exceed 4.
Hypermagnesemia Treatment Goals
- Reduce further intake: Stop magnesium-containing medications and dietary sources. Reduce/discontinue magnesium intake after resolution.
- Reduce complications: Administer IV calcium (100-200 mg elemental calcium over 5-10 minutes) to prevent cardiac/neuromuscular destabilization. Repeat doses as necessary (potentially hourly) as oral calcium is not effective.
- Eliminate excess magnesium: Use forced diuresis (0.9% or 0.45% sodium chloride and loop diuretics) in most patients EXCEPT those with anuria; urgent dialysis utilizing magnesium-free dialysate is necessary for patients requiring dialysis.
Hypomagnesemia
- Symptoms: Mostly asymptomatic; symptomatic when neuromuscular (tetany, twitching, convulsions) or cardiovascular (palpitations, arrhythmias, hypertension, sudden cardiac death).
Hypomagnesemia Treatment (Mild/Moderate):
- Mild/Moderate (≥1 mg/dL): Oral therapy is sufficient; consider IV for those with poor oral tolerance. Administer 1-2 grams IV at 1 gram/hr ( > 1.5 mg/dL) or 2-4 grams over 4-12 hours (1-1.5 mg/dL) reassessing the following morning, or sooner as clinically indicated.
Hypomagnesemia Treatment (Severe):
- Severe (<1 mg/dL): IV therapy is preferred. If hemodynamically unstable, administer 1-2 grams IV over 2-15 minutes; repeat if instability continues.
- Otherwise: Bolus then infusion with 1-2 grams over an hour, followed by 4-8 grams over 12-24 hours until magnesium levels exceed 1 mg/dL..
Oral Magnesium Products (Elemental Mg)
- Magnesium oxide: 242 mg in a 400 mg tablet (65%).
- Magnesium hydroxide: 167 mg in a 400 mg tablet or 5ml oral suspension.
- Magnesium chloride: 64 mg in a 535 mg tablet.
- Magnesium citrate: 48 mg in each 5 ml oral solution.
- Magnesium gluconate: 27 mg in a 500 mg tablet.
- Magnesium lactate: 84 mg in an 84 mg tablet.
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Description
Explore the critical information regarding magnesium levels and the management of hypermagnesemia. This quiz delves into typical ranges, treatment goals, and implications for both pregnant and non-pregnant patients. Ensure you understand the importance of monitoring and intervention in cases of elevated magnesium levels.
