Sepsis-induced Hypermagnesemia Resulting in Hypotensive Crisis and Bradycardia in an Octogenarian

Abstract

Hypermagnesemia with potential life-threatening occurs rarely in clinic. We present the case of an 85-year-old man with community acquired pneumonia with sepsis. After antibiotic treatment, fever subsided. Four days later, his blood pressure and heart beat dropped. Follow-up laboratory investigations revealed a serum magnesium level of 8.2 mg/dL (reference range, 1.7-2.55 mg/dL). Computed tomography (CT) of the abdomen demonstrated few small calcific lesions in the descending colon, which were presumed to be undigested magnesium oxide tablets on account of his history of constipation. Hypermagnesemia was successfully treated and hypotension improved after administration of intravenous calcium chloride and gastrointestinal decontamination with a magnesium-free enema. The possibility of hypermagnesemia should not be neglected when patients present with hypotension and bradycardia. Early diagnosis of hypermagnesemia is very important for preventing life-threatening effects of this condition.