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Severe hypermagnesemia without reduction in the anion gap
C J Ortiz-Interian1, F B Schlessinger, J R Oster
1Medical Service, Veterans Administration Medical Center, Miami, Fl.
Magnesium and Trace Elements
|January 1, 1990
Summary
Severe hypermagnesemia does not always lower the serum anion gap (AG). A normal or low AG finding has no predictive value for diagnosing hypermagnesemia.
Area of Science:
- Clinical Biochemistry
- Nephrology
- Internal Medicine
Background:
- The serum anion gap (AG) quantifies unmeasured anions and cations.
- Hypermagnesemia has been suggested to reduce the AG.
- The mechanism involves potential displacement of unmeasured anions by magnesium.
Observation:
- This paper details a patient with severe hypermagnesemia but a normal AG.
- The patient's normal AG was observed despite elevated serum magnesium levels.
- Concomitant conditions like lactic acidosis may influence the AG.
Findings:
- There is no established literature substantiating a consistent link between increased serum magnesium and a lowered AG.
- The presence of lactic acidosis may have counteracted potential AG reduction.
- A normal AG has no documented negative predictive value for hypermagnesemia.
Implications:
- The diagnostic utility of a normal or low AG for identifying hypermagnesemia is limited.
- Clinicians should not rely solely on AG values when suspecting hypermagnesemia.
- Further research is needed to clarify the relationship between magnesium levels and electrolyte balance.