Fatal Hypermagnesemia Due to Laxative Use

Area of Science:

• Nephrology
• Internal Medicine
• Toxicology

Background:

• Chronic obstructive pulmonary disease (COPD) exacerbations can necessitate treatments that may interact with existing conditions.
• Chronic constipation is often managed with magnesium-containing laxatives, posing a potential risk for magnesium accumulation.

Observation:

• A 53-year-old woman with COPD exacerbation and chronic constipation presented with normal kidney function.
• Her serum magnesium levels rose significantly from 2.0 mg/dL to a peak of 10.8 mg/dL despite hydration and diuresis.
• Continuous renal replacement therapy was initiated but failed to prevent progression to shock, renal failure, and death.

Findings:

• Severe hypermagnesemia can be fatal even in patients with preserved renal function.
• Magnesium-based laxatives can act as a reservoir for continuous absorption, increasing mortality risk.
• Rapid deterioration and death occurred despite prompt and aggressive medical intervention.

Implications:

• Clinicians should carefully consider the risks of magnesium-containing laxatives in patients with impaired gastrointestinal motility.
• Awareness of potential magnesium toxicity is crucial, even in the absence of renal insufficiency.
• Further research into safe laxative alternatives for patients with chronic constipation and other comorbidities is warranted.