Magnesium Treatment PDF

MAGNESIUM Typical range (institutional normal ranges may differ slightly) 1.4 – 1.7 mEq/L 1.7 – 2.3 mg/dL 0.7 – 0.95 mmol/L High alert meds: Mg sulfate  HYPERMAGNESEMIA We have a much higher panic threshold for hypermagnes...

MAGNESIUM Typical range (institutional normal ranges may differ slightly) 1.4 – 1.7 mEq/L 1.7 – 2.3 mg/dL 0.7 – 0.95 mmol/L High alert meds: Mg sulfate  HYPERMAGNESEMIA We have a much higher panic threshold for hypermagnesemia It is fairly common to induce hypermagnesemia in labor patients with pre-eclampsia → it should not be ignored!!!- Disease When we see this in non-pregnant patients → usually tied to decreased renal excretion When the Mg level goes above 4 → need to worry because of cardiac symptoms (QT interval prolongation) 3 goals.1. Reduce further intake Reducing intake requires examining home/current meds (vitamins, diet) Acutely stop anything containing magnesium Reduce/discontinue the amount of magnesium after resolution (depends on patients).2. Reduce complications Use IV calcium to prevent cardiac/neuromuscular destabilization 100 – 200 mg of elemental calcium over 5 to 10 minutes is usually sufficient Repeat doses may be required as protective effects are not long-lasting —As frequently as every hour Treatment Oral calcium WILL NOT be good enough → DO NOT USE.3. Eliminate excess magnesium Forced diuresis in most patients to make them pee Use 0.9% or 0.45% sodium chloride AND loop diuretics Do not use forced diuresis on anuric patients!!!! Patients on/requiring dialysis Urgent dialysis with magnesium-free dialysate  Disease HYPOMAGNESEMIA Most of the time, patients will be asymptomatic Symptomatic: Neuromuscular: Tetany, twitching, generalized convulsions Symptoms Cardiovascular: Palpitations, arrhythmias, hypertension, sudden cardiac death.1. Mild/moderate - ≥ 1 mg/dL (oral okay) Oral therapy is sufficient, but consider IV in patients who can’t tolerate oral meds >1.5 mg/dL – 1 to 2 grams infused at 1 gram/hr 1 – 1.5 mg/dL – 2 to 4 grams over 4 to 12 hours Reassess the next morning (sooner if clinically indicated).2. Severe/symptomatic - once the bolus is done, start the infusion Infusion only 4 – 8 grams over 12 to 24 hours Repeat until magnesium over 1 mg/dL If the patient is also hypocalcemic, may need to repeat for 3 to 5 days Oral Magnesium Products (elemental Mg) Magnesium oxide: 242 mg in a 400 mg tab – 65% Magnesium hydroxide: 167 mg in a 400 mg tab or 5 ml oral suspension Magnesium chloride: 64 mg in a 535 mg tab Magnesium citrate: 48 mg in each 5 ml oral solution Magnesium gluconate: 27 mg in a 500 mg tab Magnesium lactate: 84 mg in an 84 mg tab