Hypermagnesemia in a Constipated Female

Weng, Yiming; Chen, Shou-Yen; Chen, Hang-Cheng; Yu, Jiun-Hao; Wang, Shih-Hao

doi:10.1016/j.jemermed.2011.09.004

Cited by 31 publications

(17 citation statements)

References 7 publications

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“…If elderly people have clinical symptoms such as a disturbance of consciousness, lowered blood pressure, bradycardia, and respiratory failure, along with a history of oral administration of MgO, regardless of the dosage of oral MgO or the serum Cre value, it is desirable to measure the serum Mg value. The main causes of death involving hypermagnesemia include intestinal ischemia, intestinal necrosis, and sepsis due to a decrease in blood pressure with the serum Mg value ranging from 7.4 to 23.6 mg/dL, ≤10.0 mg/dL in one case, 10.1–15.0 mg/dL in five cases, 15.1–20.0 mg/dL in two cases, and ≥20.1 mg/dL in two cases. If it can be confirmed that respiratory failure and circulatory insufficiency are caused by severe hypermagnesemia by measuring the serum Mg value, Mg can be quickly removed by HD, which may enable lives to be saved.…”

Section: Discussionmentioning

confidence: 99%

The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis

Nishikawa

Shimada

Kanzaki

et al. 2018

Acute Medicine & Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis

Nishikawa

Shimada

Kanzaki

et al. 2018

Acute Medicine & Surgery

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“…Therefore, the possibility of the occurrence of hypermagnesaemia should be taken into account, when high doses of magnesia are prescribed. A case of hypermagnesaemia was reported in a woman with a history of coronary artery bypass surgery, hypertension and diabetes mellitus, even when low dose (1000 mg/day) of magnesia was given . Taken together, it is suggested that replacement by other class of laxatives rather than the dose elevation of magnesia is desirable in patients with renal dysfunction who received antacid.…”

Section: Discussionmentioning

confidence: 99%

“…A case of hypermagnesaemia was reported in a woman with a history of coronary artery bypass surgery, hypertension and diabetes mellitus, even when low dose (1000 mg/day) of magnesia was given. [29] Taken together, it is suggested that replacement by other class of laxatives rather than the dose elevation of magnesia is desirable in patients with renal dysfunction who received antacid. However, it does not seem to be appropriate to recommend prescribing sennoside for prevention of constipation as the effect of this compound was less marked than magnesia (Figure 2a).…”

Section: Discussionmentioning

confidence: 99%

Antacid attenuates the laxative action of magnesia in cancer patients receiving opioid analgesic

Ibuka

Ishihara

Suzuki

et al. 2016

Journal of Pharmacy and Pharmacology

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ObjectiveThis study was designed to investigate pharmacological interaction between magnesium laxative and antacid in patients receiving opioid analgesic.MethodsData obtained from a total of 441 eligible patients receiving opioid analgesic for the first time were retrospectively analysed. The incidence of constipation, defined as stool‐free interval of 3 days and more within the first week of opioid intake, was compared between patients who took laxative alone and those who received laxative in combination with antacid.Key findingsLaxatives were prescribed in 74% of patients, among them 61% received antacids such as proton pump inhibitor and H2 receptor blocker. Magnesia was the most commonly used laxative (89%). Constipation occurred in 21% and 55% of patients with and without laxatives, respectively. Antacids reversed the laxative action of lower doses (<2000 mg/day) but not higher doses (>2000 mg/day) of magnesia without affecting the effects of other laxatives. Therefore, it is suggested that both acid‐dependent and acid‐independent mechanisms may operate in the laxative action of magnesia, in which the former may be involved in the action of lower doses of magnesia.ConclusionCare should be taken to avoid the unfavourable pharmacological interaction between low doses of magnesia and antacid.

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“…27 In particular, among patients with CKD who are typically characterized by an immense burden of medications, comorbidities, and metabolic abnormalities, 62 the cause of constipation is highly multifactorial, involving many complex pathophysiological mechanisms, as summarized in Figure 2. 1,5,[63][64][65][66][67][68][69][70][71][72][73][74][75][76] Although there is a lack of consensus in the published literature, most of these predisposing factors (listed in Figure 2) appear to be shared by the general population. With a few notable exceptions, the strict dietary restrictions (e.g., low-fiber diets [to avoid hyperkalemia] and limited fluid intake [to avoid volume overload]), frequent use of constipation-inducing medications (e.g., phosphate binders, potassiumlowering agents, calcium channel blockers, opioids, iron supplements, and antidepressants), uremic toxins, and altered gut microbiota, all of which are typically present in patients with CKD, may further contribute to increase the prevalence of constipation in this particular population.…”

Section: Pathophysiology and Etiology Of Constipation In Ckdmentioning

confidence: 99%

Constipation in CKD

Sumida

Yamagata

Kövesdy

2020

Kidney International Reports

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Constipation is one of the most common gastrointestinal disorders among patients with chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g., phosphate binders), and multiple comorbidities (e.g., diabetes). Although constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of constipation. The chronic symptoms of constipation negatively affect patients' quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that constipation is independently associated with adverse clinical outcomes, such as end-stage renal disease (ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of uremic toxins and in acid-base and mineral homeostasis with declining kidney function, the presence of constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality. With the advent of new drug classes for constipation, some of which showing unique renoprotective properties, the adequate management of constipation in CKD may provide additional therapeutic benefits beyond its conventional defecation control. Nevertheless, the problem of constipation in CKD has long been underrecognized and its management strategies have scarcely been documented. This review outlines the current understanding of the diagnosis, prevalence, etiology, outcome, and treatment of constipation in CKD, and aims to discuss its novel clinical and therapeutic implications.

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Hypermagnesemia in a Constipated Female

Cited by 31 publications

References 7 publications

The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis

The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis

Antacid attenuates the laxative action of magnesia in cancer patients receiving opioid analgesic

Constipation in CKD

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