Hypermagnesemia: Lim - Madalan - Madelo - Magalit

Hypermagnesemia
LIM | MADALAN | MADELO | MAGALIT

• Hypermagnesemia (serum magnesium level higher than 2.3 mg/dL (0.95
mmol/L).is a rare electrolyte abnormality, because the kidneys efficiently
excrete magnesium.
• Normal level = 1.7 – 2.2 mg/dl (0.85 – 1.10mmol/L

• 25 grams of Magnesium in adult found in
• Half in bones
• Half in cells
- 1% in Extracellular Space
- 0.2% in proteins (albumin)
- 0.8% filtered in kidneys
KIDNEYS
Magnesium Filtered in Nephron
• 30% reabsorbed at Proximal Convoluted Tubule
• 60% reabsorbed at Ascending loop of Henle
• 5% reabsorbed at Distal Convoluted Tubule
• 5% Excreted in urine
Etiology
• Renal Failure
• Increased Intake of Antacids
• Addison’s Disease
• Tumor Lysis Syndrome
If person have healthy kidney function and does have develop
Hypermagnesemia, causes are;
• Lithium Therapy
-Decreases urinary excretion
• Hypothyroidism
-Adreno-Cortical Insufficiency
• Eclampsia
-Excessive infusion can induce iatrogenic hypermagnesemia
Pathophysiology
KIDNEY FAILURE
Decreased renal blood flow
Hypoperfusion
Decrease in GFR
Increase reabsorption of Sodium and Water at Proximal Convoluted

Tubule
Increase in Aldosterone and ADH secretion
Increase reabsorption of Sodium and Water at Distal Convoluted

Tubule
Pathophysiology
ADDISON'S DISEASE
decrease in production of Adrenal Cortex Hormone
Hypothalamus releases Cortical Tropic Hormone

Antibodies produced against Adrenal Cortex Cells
Stimulates cells into Anterior Pituitary Gland to secrete +/- Hydroxylase
Adrenocorticotropic Hormone or ACTH
ACTH will travel to Adrenal Glands • Damaging Adrenal Cortex

• Reducing production of Mineral Corticoids
Adrenal Glands
• Mineral Corticoids
• Glucocorticoids
• Androgens No negative feedback going to Hypothalamus
causing to increase serum levels
Increased in Cortisol will have negative feedback on
Hypothalamus
STOP PRODUCING ACTH!

4. Neurological impairment
CLINICAL • Occurs when there is problem in the nervous

system, which includes the brain and spinal
cord.
MANIFESTATIONS • Damage either to both:
- affects the brain’s way of processing
NON-SPECIFIC: information;
- affects the brain’s communication with the
1. Nausea
rest of the body.
2. Vomiting
3. Flushing RECAP:
• Can be also caused by a variety of health  Co-factor in 300 enzyme reaction.
conditions.
• Can be observed but further testing is
needed to be certain about the diagnosis.
 A bronchodilator, which relaxes the bronchial
5. Abnormally low blood pressure (Hypotension)
muscles and expands the airways to allow more
air to flow in and out of the lungs.
RECAP:
 Helps prevent blood vessels from constricting,
7. Headache
which can increase blood pressure. • Occurs when the muscles or blood vessels
swell, tighten, or go through changes that
6. Shortness of breath
stimulate the surrounding nerves or put
pressure on them.
RECAP:
 Important in maintaining healthy heartbeat. It
8. Fatigue
competes with calcium which is essential for
heart constrictions, by helping the cells relax.
RECAP:
 Helps maintain healthy levels of Gamma
Aminobutyric Acid (GABA).
> 2.2 mg/dL up to 7 mg/dL
• Flushing
• Nausea
• Headache
Between 7 and 12 mg/dL
• Heart
- atrioventricular heart block
- cardiac arrest
• Lungs
• Fatigue in upper end of range + Low blood
pressure
^12 mg/dL
• Muscle paralysis
• Hyperventilation
^15.6 mg/dL
• Coma
Initial approach
• Assessment of renal function review of all medications
and supplements taken by the patients an evaluation of
possible bowel motility pathology
Historical information
• Patients with mild hypermagnesemia may report nausea,
vomiting, facial flushing, difficulty urinating, and/or
constipation.
• Patients with severe hypermagnesemia may can result to
atrioventricular heart block, cardiac arrest, Low blood
pressure
• Magnesium levels should be checked in all patients with a
history of renal insufficiency and in patients with
gastrointestinal complaints requiring frequent use of
antacids or laxatives.
ASSESSMENT &
DIAGNOSTIC
FINDINGS
Physical Examination
• Vital signs may show bradycardia,
hypotension, and decreased respiratory rate;
Laboratory, radiographic and
the first two signs can be seen even in
patients with only mild hypermagnesemia other tests
• Patients with hypermagnesemia may also
have decreased deep tendon reflexes. Deep
tendon reflexes disappear as the serum • On laboratory analysis, the serum
magnesium concentration approaches 12 magnesium level is greater than 2.3
mg/dL (5.0 mmol/L); hypotension,
mg/dL (0.95 mmol/L).
respiratory depression, and narcosis develop
with increasing hypermagnesemia.
• A serum magnesium level can appear
falsely elevated
• Increased potassium and calcium are

present concurrently.
• As creatinine clearance decreases to less than 3.0
mL/min, the serum magnesium levels increase.
• ECG findings may include a prolonged PR interval,

tall T waves, a widened QRS, and a prolonged QT
interval, as well as an atrioventricular block.
• If the hypermagnesemia is severe enough, regardless

of the underlying cause, severe hypermagnesemia may
lead to complete heart block and cardiac arrest.
Laboratory, radiographic
other tests
• Hypermagnesemia can be prevented by avoiding the
administration of magnesium to patients with kidney
injury.
Medical • Carefully monitoring of seriously ill patients who are
receiving magnesium salts.
Management • In patients with severe hypermagnesemia, all parenteral
and oral magnesium salts are discontinued.
• Ventilatory support, IV Calcium gluconate
(Emergency)
• Hemodialysis
Medical
• Administration of loop diuretics (e.g., furosemide)
Management and sodium chloride or lactated Ringer IV
solution .
• IV calcium gluconate
Nursing Management
• Monitor vital signs, noting hypotension and shallow
respirations
• Observe for DTRs (deep tendon reflexes) and changes in LOC
• Medications that contain magnesium are not given to patients
with kidney injury or compromised renal function, and patients
with kidney injury are cautioned to check with their primary
providers before taking OTC medications.
• Encourage deep breathing and coughing exercise. Elevate the
head of the bed.
• Encourage bed rest; assist with personal activities, as needed.
• Encourage increased fluid intake, if appropriate.
Nursing Management
• Withhold foods high in magnesium, such as:
“Always Get Plenty Of Foods Containing Large Numbers of
Magnesium”
Avocado;
Green leafy vegetables;
Peanut Butter, potatoes, pork;
Oatmeal;
Fish (canned white tuna/mackerel);
Cauliflower, chocolate (dark);
Legumes;
Nuts;
Oranges;
Milk
• Hinkle, J. & Cheever, K. (2018). Brunner and Suddarth’s
Textbook of Medical- Surgical Nursing(14th edition).
• https://nurseslabs.com/fluid-electrolyte-imbalances-
nursing-care-plans/4/
Reference
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Hypermagnesemia

LIM | MADALAN | MADELO | MAGALIT

• Normal level = 1.7 – 2.2 mg/dl (0.85 – 1.10mmol/L

Decreased renal blood flow

Increase reabsorption of Sodium and Water at Proximal Convoluted

Increase in Aldosterone and ADH secretion

Increase reabsorption of Sodium and Water at Distal Convoluted

Hypothalamus releases Cortical Tropic Hormone

ACTH will travel to Adrenal Glands • Damaging Adrenal Cortex

STOP PRODUCING ACTH!

CLINICAL • Occurs when there is problem in the nervous

• Increased potassium and calcium are

• ECG findings may include a prolonged PR interval,

• If the hypermagnesemia is severe enough, regardless

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