Hyperm agnesemia

Immediate Questions
A. What dose of magnesium sulfate was the
patient receiving? Most patients receive 1-2
MgSO4 IV every hour. This dose is regulated
by following serum levels and changes in
physical examination such as decreased
patellar reflexes, which are suggestive of
high serum magnesium levels. Magnesium
sulfate used in patients with premature
labor may require doses of up to 3g/h.
 Immediate Questions
B. What was her last serum magnesium
level? Clinically significant
hypermagnesemia can begin to be seen at
levels as low as 4 mEq/L. Most patients who
are being maintained on magnesium sulfate
for the prevention of eclampsia will be held
at 4-6 mEq/L.
 Management
1. Magnesium. Toxicity may be seen at
levels as low as 4 meq/l. Most patients
are maintained at 4-6 meq/l to prevent
eclampsia. Respiratory depression can
appear at magnesium levels of 8-10
meq/l, and cardiotoxicity, while not
usually seen until levels exceed 10
meq/l, can occur at any serum
magnesium level.

2. Electrocardiogram. Obtain a baseline

study. Hypermagnesemia may manifest
itself as a shortened Q-T interval up
 Management
3. Calcium gluconate. Administer 1 g IV
over approximately one minute, while
waiting for serum magnesium and
electrolyte values. If calcium
administration improves the patient's
status, then magnesium toxicity is most
likely the correct diagnosis: magnesium
is a calcium antagonist, and calcium
should reverse its toxicity.
4. Urine output. Magnesium is secreted
by the kidneys. Urine output should be
maintained at a minimum of 30 mL/h.