Severe Symptomatic Hypermagnesemia Associated with Over-the-Counter Laxatives in a Patient with Renal Failure and Sigmoid Volvulus

Abstract

Hypermagnesemia is an uncommon but a potentially serious clinical condition. Over-the-counter magnesium containing products are widely used as antacids or laxatives. Although generally well tolerated in patients with normal renal function, their unsupervised use in the elderly can result in severe symptomatic hypermagnesemia, especially in those patients with concomitant renal failure and bowel disorders. We report a case of severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a 70-year-old male patient with renal failure and sigmoid volvulus, who was successfully treated with hemodialysis.

Relationship between renal function and serum magnesium concentration in elderly outpatients treated with magnesium oxide

“…According to a case report in the USA, and South Korea, and two case reports in Japan, all patients had some degree of bowel disorder and all took magnesium-containing laxatives. 11,[17][18][19] In these cases, hypermagnesemia had an iatrogenic cause. Constipation is a common health problem in older adults.…”

“…There are several reports on the correlation between intake of magnesium‐containing laxatives and symptomatic hypermagnesemia worldwide. According to a case report in the USA, and South Korea, and two case reports in Japan, all patients had some degree of bowel disorder and all took magnesium‐containing laxatives . In these cases, hypermagnesemia had an iatrogenic cause.…”

Clinical features of hypermagnesemia in patients with functional constipation taking daily magnesium oxide

“…High CKD, greater age, and long-term use of magnesium oxide were shown to be risk factors for hypermagnesemia. (3,(5)(6)(7)(8)(9)(10) Most of these studies, however, were case reports or studies of certain groups, including elderly patients, children, and patients undergoing hemodialysis. The results of the present retrospective cohort study showed that reduced renal function was the most important risk factor for hypermagnesemia and high serum magnesium concentration in patients taking magnesium oxide for functional constipation.…”

“…(4)(5)(6)(7)(8)(9) Serum magnesium concentrations >5.0 mg/dl have been associated with nausea, headache, light-headedness, and cutaneous flushing, whereas levels above 12 mg/dl have been associated with respiratory failure, complete heart blockage, and cardiac arrest. (10) Recently, the Japanese Ministry of Health, Labour and Welfare recommended that serum magnesium concentrations be measured periodically in geriatric patients and in patients administered magnesium oxide for prolonged periods of time (http://www.pmda. go.jp/files/000219708.pdf).…”

Magnesium bei Hund und Katze – physiologische Aspekte, Messung und Störungen im Magnesiumhaushalt

“…In der Humanmedizin finden sich einige Fallberichte zu einer Hypermagnesiämie aufgrund iatrogener parenteraler Überdosierung sowie oraler Gabe von Antazida, magnesiumhaltigen Ab-führmitteln und Durchführung magnesiumhaltiger Einläufe (16,47,53).…”