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Unsuspected morbid hypermagnesemia in elderly patients
1Charles A. Dana Research Institute, Harvard-Thorndike Laboratory, Beth Israel Hospital, Boston, MA 02215.
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 > or = 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.
Insights
Severe hypermagnesemia, often unsuspected, can occur in elderly patients with bowel disorders even without severe kidney issues. This condition can lead to serious cardiovascular and neurological problems.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Toxicology
Background:
- Investigate the incidence, causes, and outcomes of severe hypermagnesemia.
- Retrospective analysis of hospital admissions over a 5-year period (1984-1989).
Observation:
- Identified 8 cases of severe hypermagnesemia (serum Mg ≥ 6.0 mg/dL) primarily from magnesium ingestion.
- Most affected patients were elderly (mean age 70 years) and had underlying bowel disorders enhancing absorption.
- Renal insufficiency was not a prerequisite; only 1 patient had pre-existing renal failure.
Findings:
- Etiologies included magnesium-containing cathartics and antacids.
- Clinical consequences: hypotension (7/8), bradycardia (2/8), respiratory depression (3/8), EKG abnormalities (6/8), and altered mental status (5/8).
- Associated hypocalcemia (5.7-7.4 mg/dL) and low anion gap (range -2 to 9) were noted in several patients.
Implications:
- Severe hypermagnesemia can occur in elderly individuals with bowel disease, even with normal or mildly impaired renal function.
- It may be an underdiagnosed cause of cardiovascular dysfunction, hypocalcemia, and neurological/respiratory compromise.
- Highlights the importance of considering magnesium toxicity in elderly patients presenting with unexplained symptoms, especially after ingesting magnesium-containing products.