II. Definition

  1. Serum Magnesium over 2.5 meq/L

III. Symptoms

  1. Muscle Weakness
  2. Headache
  3. Excessive thirst

IV. Signs

  1. Hyporeflexia
  2. Severe findings (Serum Magnesium >10 mEq/dl)
    1. Bradyarrhythmia
    2. Hypotension
    3. Respiratory depression
    4. Pulmonary Edema

VI. Labs

  1. See Serum Magnesium
  2. Serum Magnesium Interpretation
    1. Normal in pregnancy: 1.3 to 2.6 mg/dl
    2. Therapeutic: 5.5-7.5 mg/dl
    3. Loss of Patellar Reflex: 10-12 mg/dl
    4. Respiratory depression: 15-17 mg/dl
    5. Paralysis: 15-17 mg/dl
    6. Cardiac Arrest: 30-35 mg/dl

VII. Management

  1. Stop all Magnesium Sources
  2. Supportive Care with ABC Management
  3. Dialysis
  4. Cardiotoxicity Management: Calcium
    1. Calcium Chloride (1.4 mEq/ml)
      1. Dose: 5 ml over 10 minutes
      2. May repeat second dose in 5 minutes if EKG not improved
      3. Preferred historically for shock or cardiac instability (especially if central access)
        1. However Calcium Gluconate likely has same efficacy with better peripheral IV safety
        2. See Intravenous Calcium for differences between Calcium preparations
    2. Calcium Gluconate 10% (0.4 mEq/ml)
      1. Preferred agent if only peripheral IV available (Decreased venous sclerosis with infusion)
      2. Initial dose: 10 ml over 2-5 minutes (10 minutes is lower risk if time allows)
      3. Second dose after 5 minutes if EKG not improved
      4. Advantages over Calcium Chloride

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Related Studies

Ontology: Hypermagnesemia (C0151714)

Concepts Disease or Syndrome (T047)
ICD10 E83.41
SnomedCT 66978005
English HYPERMAGNESEMIA, HYPERMAGNESAEMIA, hypermagnesemia (diagnosis), high blood magnesium level, hypermagnesemia, Hypermagnesemia, hypermagnesaemia, Hypermagnesaemia, Hypermagnesemia (disorder)
Italian Ipermagnesiemia
Japanese 高マグネシウム血症, コウマグネシウムケツショウ, コウマグネシウムケッショウ
Portuguese HIPERMAGNESEMIA, Hipermagnesemia
Spanish HIPERMAGNESEMIA, hipermagnesemia (trastorno), hipermagnesemia, Hipermagnesemia
French HYPERMAGNESEMIE, Hypermagnésémie
German HYPERMAGNESIAEMIE, Hypermagnesiaemie
Czech Hypermagnezemie
Hungarian Hypermagnesaemia
Dutch hypermagnesiëmie