Unsuspected Morbid Hypermagnesemia in Elderly Patients

Abstract

This study was designed to determine the incidence, etiology and consequences of severe hypermagnesemia. We retrospectively reviewed all hospital admissions over a 5-year period from 1984 to 1989 and identified 8 cases of severe hypermagnesemia (serum Mg ≧ 6.0 mg/dl) due to magnesium ingestion. All but 1 patient were elderly (mean age 70 ± 6 years). The etiology when identified was due to magnesium-containing cathartics (n = 3) or antacids (n = 3). The total amount of magnesium ingested was not excessive, but bowel disorders that may have enhanced absorption (such as active ulcer disease, gastritis, colitis, perforated viscus, massive gastric dilatation) were present in 7 of the 8 patients. Unexpectedly, only 1 had preexisting renal failure. Renal function was found to be normal in 1, only mildly to moderately impaired in 5 (creatinine < 3.6 mg/dl) and severely impaired in 2 (creatinine 7.6, 15.7 mg/dl). Clinical sequelae of hypermagnesemia were hypotension (n = 7), bradycardia (n = 2), respiratory depression (n = 3), EKG abnormalities (n = 6), depressed mental status (n = 5). Hypocalcemia (range 5.7-7.4 mg/dl) more severe than could be attributed to either hypoalbuminemia or acute renal failure was present in 7. A low anion gap (range -2 to 9) was present in 5. Most striking was the fact that despite clinical sequelae, the hypermagnesemia was unsuspected in 6 of the 8 cases. Hypermagnesemia can occur without severe renal insufficiency in association with bowel disease, particularly in elderly individuals, and may be a clinically unrecognized cause of cardiovascular dysfunction, hypocalcemia and neurologic or respiratory depression.

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

“…Hypermagnesemia is considered to be rare (1) and usually iatrogenic; occurring, for example, after intravenous Mg administration (2,3), oral ingestion of Mg-containing antacids or cathartics (4-7), or procedure-related retroperitoneal (8) or peritoneal (1, 9) leakage of Mg-containing preparations. The kidney is the principal organ involved in Mg regulation (10), and therefore hypermagnesemia commonly occurs in the presence of renal failure.…”

Catharticinduced Fatal Hypermagnesemia in the Elderly

“…Hypermagnesemia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Among the 13 reported cases, 4 patients had succumbed to death (3,4,9,10).…”

Volumen- und Elektrolytstörungen bei Darm- und Nierenerkrankungen

“…enterologischen Erkrankungen beobachtet, die zu relevanten neuromuskulären Symptomen führen kann [6].…”