Hypermagnesemia Induced by Massive Cathartic Ingestion in an Elderly Woman without Pre-existing Renal Dysfunction

Kontani, Makoto; Hara, Akinori; Ohta, Setsuko; Ikeda, Takayuki

doi:10.2169/internalmedicine.44.448

Cited by 77 publications

(69 citation statements)

References 14 publications

(18 reference statements)

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“…Despite of all these beneficial effects, Mg replacement or Mg containing agents like cathartics and antacids may cause severe or fatal hypermagnesemia even in patients without pre-existing renal dysfunction [39] . Potential harmful effects of elevated Mg include altered nerve conduction velocity, increased pruritus, and alterations to osseous metabolism and parathyroid gland function (mineralization defects, contribution to osteomalacic renal osteodystrophy and adynamic bone disease) [40] .…”

Section: The Beneficial Effect Of Mg In the General Populationmentioning

confidence: 99%

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

Kanbay¹,

Goldsmith

Uyar

et al. 2010

Blood Purif

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Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease, which is partly explained by the fact that 40–70% of patients receiving dialysis have significant coronary artery disease. Recent clinical studies have shown that lower serum magnesium (Mg) levels are associated with vascular calcification and cardiovascular mortality among patients with end-stage renal disease (ESRD). On the other hand, hypermagnesemia inhibits parathyroid hormone secretion, which is considered an important independent risk factor for vascular calcification, left ventricular hypertrophy and mortality in ESRD patients. Finally, increasing evidence points towards a link between Mg and cardiovascular disease, even in subjects without chronic kidney disease. The purpose of this review was to critically review the current literature examining the effects of plasma Mg levels on cardiovascular disease and parathyroid hormone homeostasis in ESRD, and renal transplant patients.

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Section: The Beneficial Effect Of Mg In the General Populationmentioning

confidence: 99%

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

Kanbay¹,

Goldsmith

Uyar

et al. 2010

Blood Purif

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“…For the bradycardia and hypotension in the present case, we administered an intravenous infusion of 0.9% saline and vasopressor agents, including atropine and dopamine [21]. Another putative mechanism of bradycardia and hypotension is hypermagnesemia, which generally occurs with renal insufficiency and excessive magnesium intake [20,28,29,30]. As mentioned earlier, Fuzi is prepared by soaking in brine, of which the major components are magnesium chloride, magnesium sulfate, magnesium bromide, potassium chloride and sodium chloride.…”

Section: Discussionmentioning

confidence: 99%

“…1). Based on these preliminary data, the possible differential diagnoses were age-related sick sinus syndrome, coronary artery disease compromising the arteries supplying the sinoatrial node, endocrine diseases associated with declining general cardiac activity, such as hypothyroidism or adrenal insufficiency, medication-related side effects, or long QT syndrome [20,21,22]. She was immediately administered an intravenous (IV) infusion of 0.9% of normal saline (80 ml/h), 2 ampules dopamine (200 mg/5 ml/ampule, with an IV drip at 10 ml/h, 5.3 μg/kg/min), atropine 0.5 ampule (1 mg/1 ml/ampule, as an IV bolus), and oxygen inhalation (10 l/min).…”

Section: Case Reportmentioning

confidence: 99%

Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

et al. 2018

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Background: Adverse reactions associated with Chinese herbal medicines (CHMs) are usually the result of unpredictable active/toxic ingredients, inaccurate or mistaken beliefs, or poor supervision. The herb that most commonly induces severe adverse effects in Hong Kong and China is aconite root. More than 200 species of Aconitum plants are used for medicinal purposes, with aconite roots producing analgesic, anti-inflammatory, cardiotonic, and anti-tumor effects. The active components are alkaloids; these can be toxic, but CHM processing methods lower their toxicity and increase the pharmacological efficacy. However, aconite poisoning can result from inadequate decoction time or exceeding the recommended dose. Case Report: Here we report the case of a 92-year-old woman who presented with life-threatening bradycardia and hypotension. This started 1 h after she inappropriately consumed a herbal decoction containing Fuzi for mood fluctuation and health maintenance; Fuzi, an aconite root, has known cardiotoxicity. Electrocardiography showed supraventricular abnormalities, including sinus bradycardia and low-amplitude P waves. After an infusion of normal saline and inotropic agents for 25 h, the clinical manifestations subsided, her sinus rhythm returned to normal, and she was discharged. At follow-up 2 weeks later, she was in good health and had ceased taking any CHM. Conclusions: Standardized processing methods, stringent regulations, and cooperation between health professions can ensure medication safety and establish a fully-fledged operating process for these valuable drugs. We hope this report will help establish correct attitudes toward CHM and will assist Traditional Chinese Medicine practitioners to become more familiar with Aconitum plants.

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“…Magnesium citrate causes electrolyte and fluid disturbances, especially in patients with renal dysfunction. Cases of hypermagnesemia have been reported in elderly patients after magnesium citrate preparations even without known kidney disease (Kontani et al, 2005;Schelling, 2000). Polyethylene glycol (PEG) does not, in general, cause fluid and electrolytes imbalance.…”

Section: Elderlymentioning

confidence: 99%

Preparing for Colonoscopy

Deepak¹,

Sifuentes²,

Sherid³

et al. 2011

Endoscopic Procedures in Colon and Rectum

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Endoscopic Procedures in Colon and Rectum 18 followed by repeated procedures. In a study of 200 consecutive outpatient colonoscopies, imperfect bowel preparation resulted in a 12% increase in costs at a university hospital and 22% increase in costs at a public hospital (Rex et al., 2002). Types of bowel preparationsThe ideal colon preparation should rapidly and reliably cleanse the colon of fecal material while having no effect on the gross or microscopic appearance of the colon (Wexner et al., 2006). It should require a short period for ingestion and evacuation, cause no discomfort, and produce no significant fluid or electrolyte shifts while also being palatable, simple, and inexpensive. Agents used for bowel preparation can be divided into three main categories according to their mechanism of action, these being isosmotic, hyperosmotic, and adjunctive preparations. Polyethylene glycol-electrolyte lavage solutions (PEG-ELSs) and sodium phosphate (NaP) formulations are among the most commonly used. 2.2

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Hypermagnesemia Induced by Massive Cathartic Ingestion in an Elderly Woman without Pre-existing Renal Dysfunction

Cited by 77 publications

References 14 publications

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

Preparing for Colonoscopy

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