Magnesium overdose
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Understanding Magnesium Overdose: Clinical Manifestations, Causes, and Management
Clinical Manifestations of Magnesium Overdose
Cardiovascular and Neurologic Symptoms
Magnesium overdose, particularly when administered intravenously, can lead to severe cardiovascular and neurologic symptoms. Common manifestations include vomiting, hypotension, bradycardia, flaccid paralysis, and severe mental depression . In extreme cases, patients may experience cardiac conduction delays, asystole, apnea, and coma, which are life-threatening conditions 24.
Respiratory Depression and Neuromuscular Deterioration
In some instances, magnesium toxicity can result in acute neuromuscular deterioration and respiratory depression. This was observed in a case where repeated doses of magnesium citrate, administered with activated charcoal, led to a significant increase in serum magnesium levels, necessitating dialysis for hypermagnesemia control .
Causes of Magnesium Overdose
Iatrogenic Errors
A significant cause of magnesium overdose is iatrogenic, often due to miscalculations in treatment orders or errors in drug administration. For example, confusing drug labels and varying units of measurement can lead to erroneous administration of magnesium-containing solutions, especially in critically ill patients receiving multiple IV infusions 12. In one reported case, a nurse mistakenly administered two 25-g single-dose vials of magnesium sulfate instead of the prescribed 2 g, resulting in severe bradycardia, hypotension, and apnea .
Excessive Ingestion
Magnesium overdose can also occur due to excessive ingestion of magnesium compounds, such as magnesium hydroxide. Although magnesium hydroxide is commonly used as a laxative, its overdose can lead to hypermagnesemia, even in the absence of kidney dysfunction. This can paradoxically result in hypomagnesemia due to induced diarrhea and subsequent excessive magnesium loss .
Management and Treatment of Magnesium Overdose
Immediate Interventions
Prompt recognition and supportive care are crucial in managing magnesium overdose. Treatment typically involves the administration of intravenous calcium gluconate to counteract the effects of hypermagnesemia and the use of 0.9% NaCl for diuresis to help normalize serum magnesium levels . In severe cases, such as those involving respiratory depression or cardiac arrest, dialysis may be required to control hypermagnesemia .
Education and Prevention
To prevent iatrogenic magnesium overdose, it is essential to educate healthcare personnel about the dosing regimens and adverse effects associated with magnesium administration. Ensuring clear and accurate drug labeling and standardizing units of measurement can significantly reduce the risk of administration errors .
Conclusion
Magnesium overdose, whether due to iatrogenic errors or excessive ingestion, can lead to severe and potentially life-threatening symptoms. Prompt recognition and appropriate management are essential to mitigate the adverse effects. Preventative measures, including proper education and clear labeling, are critical to reducing the incidence of such overdoses.
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