Hypermagnasaemia

1. Is the patient unwell?

• ABCDE approach 

2. Is the result a true value?

• Could the sampling method have affected the result?
• Is there a previous level?

3. Does the patient have any symptoms or signs?

• May indicate the significance and rapidity of electrolyte change
• Hypotension, bradycardia, respiratory depression, mood instability, hyper-reflexia, muscle weakness
• ECG - concern if widened QRS, peak T waves and potentially cardiac conduction blocks

4. Are there culprit drugs? - consider stopping them

• Excess magnesium, antacids, laxatives

5. Causes? - treat them

• normally iatrogenic
• tumour lysis syndrome, rhabdomyolysis
• Occasionally associated with severe renal dysfunction

• If renal dysfunction – please contact on-call renal registrar urgently

• Otherwise if mild and renal function normal – remove cause
• Severe hypermagnasaemia with associated muscle involvement or arrhythmia is exceptionally rare and a medical emergency. If you have concerns regarding this then call 2222 medical emergency and give an initial bolus of 10ml 10% calcium gluconate in 50ml 5% dextrose over 10 minutes pending ICU review

Seek senior advice if concerns

• Severe hypermagnasaemia with associated muscle involvement or arrhythmia is exceptionally rare and a medical emergency. If you have concerns regarding this then call 2222 medical emergency and give an initial bolus of 10ml 10% calcium gluconate in 50ml 5% dextrose over 10 minutes pending ICU review

Cardiac monitoring or HDU review?

• Cardiac monitoring needed if clinical concern only if patient a candidate for escalation of care