Antacid-induced hypermagnesemia in a patient with normal renal function and bowel obstruction
Antacid-induced hypermagnesemia in a patient with normal renal function and bowel obstruction
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DOI：
10.1345/aph.17284
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发表时间：
1998-03-01
影响因子：
2.9
通讯作者：
McKinney, PE
中科院分区：
文献类型：
--
作者：
McLaughlin, SA;McKinney, PE
目的：报告一例严重高镁血症引起的氢氧化镁在一名妇女与正常renal functions.CASE摘要：一名42岁的西班牙裔妇女精神分裂症和双相情感障碍从监狱运送到急诊科混乱，腹痛，呕吐，便秘。她在监狱里接受了氢氧化镁治疗，每晚口服30毫升镁乳，每天口服30吨Maalox。其他药物包括碳酸锂300 mg po每日3次、氯丙嗪150 mg po每日3次、甲磺酸苯扎托品1 mg po每日2次和多库酯钠100 mg po每日早晨。她的体温为35.1摄氏度，血压为108/58毫米汞柱，心率为112次/分，呼吸频率为24次/分。她的腹部肿胀，并有弥漫性压痛。实验室检查包括血清镁浓度9.1 mEq/L（正常值1.3-2）、血尿素氮16 mg/dL（8-22）、肌酐0.9 mg/dL（0.5-1.1）、钙3.9 mEq/L（4.2-5.2）和锂1.0 mEq/L。进行剖腹手术，发现先前卵巢切除术的粘合带压迫乙状结肠。高镁血症、低体温和低血压在重症监护室持续存在。尽管用钙、静脉输液和速尿成功治疗了高镁血症，但患者的心律在术后第2天退化为致命的无脉电活动。讨论：本例氢氧化镁摄入引起的严重高镁血症说明了肾功能正常患者高镁血症的许多危险因素。使用含镁药物缓解胃肠道不适的人可能会增加高镁血症的风险。简要回顾镁的生理，临床效果和治疗。鼓励经常使用实验室来确定高镁血症，因为它通常是临床上意想不到的发现，并对早期治疗反应良好。
OBJECTIVE: To report a case of severe hypermagnesemia caused by magnesium hydroxide in a woman with normal renal function.CASE SUMMARY: A 42-year-old Hispanic woman with schizophrenia and bipolar affective disorder was transported from jail to the emergency department with confusion, abdominal pain, vomiting, and constipation. She had been treated in jail with magnesium hydroxide, ordered as milk of magnesia 30 mL po each night and Maalox 30 mt po three times daily. Additional medications included lithium carbonate 300 mg po three times daily, chlorpromazine 150 mg po three times daily, benztropine mesylate 1 mg po twice daily, and docusate sodium 100 mg po each morning. Her temperature was 35.1 degrees C, blood pressure 108/58 mm Hg, heart rate 112 beats/min, and respiratory rate 24 breaths/min. She would respond only briefly to voice or painful stimuli. Her abdomen was distended and diffusely tender. Laboratory tests included serum magnesium concentration 9.1 mEq/L(normal 1.3-2), blood urea nitrogen 16 mg/dL (8-22), creatinine 0.9 mg/dL (0.5-1.1), calcium 3.9 mEq/L (4.2-5.2), and lithium 1.0 mEq/L. A laparotomy was performed, and an adhesive band from a previous oophorectomy was found to be compressing the sigmoid colon. Hypermagnesemia, hypothermia, and hypotension continued in the intensive care unit. Despite successful treatment of the hypermagnesemia with calcium, intravenous fluids, and furosemide, the patient's cardiac rhythm degenerated into fatal, pulseless electrical activity on postoperative day 2.DISCUSSION: This case of severe hypermagnesemia from magnesium hydroxide ingestion illustrates many of the risk factors for hypermagnesemia in patients with normal renal function. People using magnesium-containing medications for relief of gastrointestinal distress may be at increased risk for hypermagnesemia. A brief review of magnesium physiology, clinical effects, and treatment is provided. Frequent use of the laboratory to identify hypermagnesemia is encouraged because it is often a clinically unexpected finding and responds well to early treatment.