Abstract
AimThis study aimed to clarify the characteristics of patients who presented with severe hypermagnesemia and subsequently underwent emergency hemodialysis.MethodsWe investigated the age, gender, complications, clinical symptoms, causal drugs, electrocardiogram findings, and laboratory data of 15 patients.ResultsMagnesium oxide had been administered in all cases and 14 patients were over 65 years old. The male : female ratio was 6:9. Chief complaints included a disturbance of consciousness, hypotension, bradycardia, and respiratory failure. The median serum magnesium value before hemodialysis was 6.0 (3.7–18.6) mg/dL. The daily dosage of magnesium oxide was ≤ 2.0 g in 12 cases. The median serum creatinine value before hemodialysis was 5.39 (0.54–10.29) mg/dL. However, in two cases, the creatinine value was not elevated. Complications of acute kidney injury exacerbated the hypermagnesemia in nine cases.ConclusionsWe recommend that the serum magnesium value should be measured in older patients who are taking magnesium oxide and are showing signs and symptoms of a disturbance of consciousness, hypotension, bradycardia, and respiratory failure of an uncertain etiology, even if the serum creatinine value is not elevated or the dosage of magnesium oxide is within recommended levels.
Highlights
The indications to carry out emergency HD for hypermagnesemia at our hospital included fatal clinical symptoms due to hypermagnesemia and a decision that HD was necessary for the removal of Mg
The clinical symptoms observed before HD included 10 cases of a disturbance of consciousness, five cases with lowered blood pressure, five cases of bradycardia, and two cases of respiratory failure
Clinical symptoms before HD included a disturbance of consciousness (67%), lowered blood pressure (33%), bradycardia (33%), and respiratory failure (13%)
Summary
M AINTAINING MAGNESIUM (MG) in the body in just the right proportion is essential for life.[1]. Mg plays a role as a cofactor in multiple enzymatic reactions such as energy metabolism and DNA and protein synthesis, and Mg is related to the regulation of ion channels.[1]. Because Mg acts as a calcium channel blocker,[2,3] the blood vessels tend to dilate, which leads to lower blood pressure levels, and it causes prolonged QT interval, increased QRS duration, and bradycardia on electrocardiograms, and cardiac arrest.[3]. Reports exist on hypermagnesemia requiring urgent hemodialysis (HD),[6] there are few reports on the characteristics of such cases. We retrospectively analyzed cases of hypermagnesemia requiring emergency HD at our hospital and investigated the characteristics of these patients. + Magnesium aluminometasilicate 0.48 1.43 2.95† 2.07† Y
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