Hypocalcemia and hyperkalemia during magnesium infusion therapy in a pre‐eclamptic patient

Hudali, Tamer; Takkar, Chandandeep

doi:10.1002/ccr3.356

Cited by 16 publications

(26 citation statements)

References 23 publications

(26 reference statements)

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“…In preeclampsia, it has been reported that a decrease glomerular filtration rate (GFR) and renal plasma flow (RPF) possibly decreases sodium delivery to the distal nephron as well as causing decreased potassium secretion [ 19 ]; thus suggesting the possibility of inhibition of urinary potassium excretion prior to administration of magnesium in some preeclamptic women [ 19 ]. An increase in the mean plasma potassium as observed in preeclamptic patients may also possibly be secondary to the effect of magnesium sulphate infusion therapy as Hudali and Takkar [ 20 ] as well as Iglesias et al [ 21 ] reported hypocalcaemia and hyperkalemia during magnesium infusion therapy in preeclamptic patients. It is thought that administration of magnesium in the treatment of preeclampsia possibly reduces the activity of plasma renin and angiotensin converting enzymes resulting in low levels of renin, angiotensinogen, angiotensin II, and aldosterone [ 19 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis

Ekun

Olawumi

Makwe

et al. 2018

International Journal of Reproductive Medicine

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Objectives Preeclampsia is a pregnancy specific syndrome. Studies have shown that preeclampsia has multiorgan dysfunction effects. This study evaluated biomarkers of renal and liver function among preeclamptic Nigerian women. Study Design This was a cross-sectional study conducted among 49 preeclamptic women and 50 normotensive healthy pregnant women. Method The baseline data comprising age, gestational age, and blood pressure were obtained. Venous blood and spot urine samples were collected from each participant. Plasma obtained from blood samples taken into lithium heparinized vacutainer bottles was assayed for electrolytes, urea, creatinine, total protein, albumin, and uric acid, while sera samples from blood samples taken into serum separation tube- (SST-) gel vacutainer were assayed for aspartate transaminase and alanine transaminase using ion selective electrode technique and Cobas autoanalyzer. Spot urine samples were assayed for protein and creatinine using Pyrogallol's reagent and Jaffe's methods, respectively. Microalbuminuria (protein/creatinine ratio) was generated from spot urine protein and creatinine data. Result The plasma sodium, total protein, and albumin in preeclamptic group were significantly decreased (p<0.05) when compared with control. There was statistically significant increase (p<0.05) in microalbuminuria, plasma potassium, urea, creatinine, uric acid levels, serum AST, and ALT activities in preeclamptic group. A positive association (p<0.05) between alanine aminotransferase and biomarkers of renal function was observed. Conclusion Preeclampsia has deleterious effects on renal and liver function as shown by alteration of these parameters.

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Section: Discussionmentioning

confidence: 99%

Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis

Ekun

Olawumi

Makwe

et al. 2018

International Journal of Reproductive Medicine

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“…The recommended range of total magnesium is between 4.8 and 8.4 mg/dL [8, 9]. It was discovered that most patients had lower total magnesium level than what has been recommended in the guidelines (<4.8 mg/dL).…”

Section: Resultsmentioning

confidence: 99%

“…Many physicians used 1.0 and 1.5 g maintenance dose in their patients’ treatment as it was believed to reduce major side effects, such as hot flashes, blurred vision, and sweating. Interestingly, up to 56.5% of the patients had serum magnesium lower than the recommended therapeutic level (4.8–8.4 mg/dL) [8, 9]. Especially, patients who received 1.0 g/h of magnesium sulfate (88.9%).…”

Section: Discussionmentioning

confidence: 99%

“…According to the current recommendations, magnesium sulfate is administered as an initial infusion of a 4 mg loading dose followed by a continuous infusion at 1–2 mg/h for the first 24 h post-delivery. Serum magnesium must be closely monitored and maintained at 4.8–8.4 mg/dL to ensure therapeutic levels [8, 9]. Despite its theoretical ability to reduce peripheral vascular resistance, there is currently no evidence demonstrating that magnesium is capable of reducing blood pressure [10].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Magnesium on Glomerular Filtration Rate and Recovery of Hypertension in Women with Severe Preeclampsia

Kreepala

Luangphiphat

Villarroel

et al. 2017

Nephron

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Introduction: Magnesium sulfate is used for preventing seizures in patients with severe preeclampsia. Previous studies have demonstrated that magnesium plays a significant role in the endothelial function and might have clinically beneficial vasodilating properties. Objectives: This study is aimed at evaluating the effect of magnesium sulfate on the glomerular filtration rate (GFR) during the first 24 h after delivery and during the duration of recovery from hypertension in preeclampsia. Methods: Severe preeclamptic patients who had normal serum creatinine levels (0.4–0.8 mg/dL) were included in the study. Twenty-three women with severe preeclampsia were divided into groups of 9, 8, and 6, and given 1.0, 1.5, and 2.0 g/h of magnesium sulfate, respectively. Magnesium sulfate infusion was used as seizure prophylaxis for 24 h after delivery. The cystatin C-based GFR was monitored for 24 h, and the blood pressure was recorded for 12 weeks postpartum. Results: Despite the minimal improvement of GFR 24-h after treatment initiation, survival analysis demonstrated a statistically significant relationship (log rank, p = 0.04) between magnesium dosage and recovery period from hypertension. The group receiving 2.0 g/h of magnesium experienced the shortest recovery period from hypertension (6.5 ± 1.8 days). Meanwhile, the other groups required 66.0 ± 26.9 and 48.3 ± 15.6 days to recover after 1.0 and 1.5 g/h of magnesium infusion, respectively. Conclusion: Magnesium sulfate has no impact on GFR improvement during the first 24 h after delivery. However, magnesium maintenance infusion at 2.0 g/h is capable of preventing seizure by optimizing the therapeutic magnesium level (4.8–8.4 mg/dL) and shortening the hypertensive episode in preeclampsia.

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“…Inadvertent overdose of magnesium can be lethal in dogs and human beings 29 43. Excessive magnesium supplementation can result in hypocalcaemia and hyperkalaemia, the latter due to mechanisms which remain not fully understood 44. Hypermagnesaemia decreases the conductivity of cardiac pacemakers by suppression of calcium channels.…”

Section: Discussionmentioning

confidence: 99%

Reversal of sustained ventricular tachycardia with magnesium but not with lidocaine in a dog during the perianaesthetic period

Ranninger

Bartoszuk

Kutter

2019

Vet Record Case Reports

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A one-and-a-half-year-old, male neutered Pyrenean mountain dog was presented with bleeding after orchiectomy at a private veterinary practice. Drops of blood were emerging from the surgical site. Clinical evaluation evidenced slightly pale mucous membranes and a mildly elevated heart rate. Preoperative blood testing revealed a mild hyperlactataemia. Due to the haemorrhage, anaesthesia was induced for surgical ligation of the vessel. During dissection of the testicular vessels, repeated episodes of sudden sustained ventricular tachycardia (heart rate >190 beats per minute, lasting about one minute) and hypotension were observed. Despite repeated intravenous lidocaine boluses (8 mg/kg total) and a constant rate infusion (80 μg/kg/minute), the ventricular tachycardia did not cease. After an intravenous magnesium infusion, a sinus rhythm returned within 20 minutes of administration. In view of ventricular tachycardia resistant to conventional therapies, magnesium administration might be a safe adjuvant pharmacological option, as described in the case herein.

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Hypocalcemia and hyperkalemia during magnesium infusion therapy in a pre‐eclamptic patient

Cited by 16 publications

References 23 publications

Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis

Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis

Effect of Magnesium on Glomerular Filtration Rate and Recovery of Hypertension in Women with Severe Preeclampsia

Reversal of sustained ventricular tachycardia with magnesium but not with lidocaine in a dog during the perianaesthetic period

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