DOCSLIB.ORG

Mental Change, Cardiovascular Depression and QT Prolongation Caused by Severe Hypermagnesemia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Mental Change, Cardiovascular Depression and QT Prolongation Caused by Severe Hypermagnesemia 대한중환자의학회지：제 23 권 제 2 호 ■ 증례■ Vol. 23, No. 2, December, 2008 Mental Change, Cardiovascular Depression and QT Prolongation Caused by Severe Hypermagnesemia A Case Report Hyung Oh Choi, M.D., Seung Geun Lee, M.D., Pil Hyung Lee, M.D., Sung Nam Lim, M.D., Byeong Seok Sohn, M.D., Yun Hee Chung, M.D. and Gi-Byoung Nam, M.D. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea A 50-year-old woman was referred to our hospital for evaluation of mental change and general weakness accompanied by an irregular and weak pulse. She had previously been diagnosed with Bartter’s syndrome and had taken potassium-sparing diuretics. She had developed constipation that had led to abdominal pain and had taken excessive magnesium oxide over a long time. On admission, she was lethargic. Her blood pressure (BP) was 130/74 mmHg, with a heart rate varying from 30 to 78 beats/min. An electrocardiogram (ECG) revealed several abnormalities, including first degree AV block, QT prolongation, sinus pause with a junctional rhythm, and paroxysmal tachycardia alternating with sinus pause. Her serum concentration of magnesium was markedly elevated to 16.19 mg/dl. Hemodialysis and a calcium gluconate infusion was attempted to reduce magnesium levels and to counteract the cardiovascular effect of magnesium. As magnesium levels declined, her general medical condition improved and her ECG changes were normalized. Severe hypermagnesemia should be suspected as the cause of mental change, cardiovascular dysfunction, and variable ECG changes. Key Words: hypermagnesemia, magnesium oxide. Hypermagnesemia is fairly rare and is usually considered ECG changes. iatrogenic. The kidney is the principal organ involved in mag- nesium regulation.1) As magnesium loads increase, the kidney CASE REPORT increases magnesium excretion. A healthy adult can excrete more than 6 g of magnesium daily,2) and symptomatic hyper- A 50-year-old woman was referred to the emergency depart- magnesemia develops almost exclusively in the presence of re- ment for drowsy mentality and bradyarrhythmia. Since being nal insufficiency. Recent reports suggest that hypermagnesemia diagnosed with Bartter’s syndrome 18 years previously, she can occur without severe renal insufficiency, for example when had taken potassium-sparing diuretics. She had been admitted the patient has a bowel disease.3-7) Increased plasma magne- previously for major depression with borderline personality sium concentrations can lead to neuromuscular suppression and disorder. She had severe constipation and abused magnesium- cardioinhibitory action with hypocalcemia.2,8-10) Cardioinhibitory containing cathartics (magnesium oxide), taking 6 g a day for actions include prolongation of PR interval, increase in QT in- 10 years. Four days prior to admission, her general weakness terval, conduction delay, and complete heart block.2,3,10) We de- became aggravated and she began to feel chest discomfort. On scribe a patient with severe hypermagnesemia who presented the day of admission, she was found to be lethargic and she with mental change, cardiopulmonary depression, and variable did not respond well to verbal stimuli. She was then trans- ferred to the emergency department for evaluation of mental Received on July 30, 2008, Accepted on October 29, 2008 change, azotemia, ileus, and bradyarrhythmia. Correspondence to: Gi-Byoung Nam, Department of Internal Medicine, University of Ulsan College of Medicine, 388-1, Poongnap- On admission to the emergency department, she responded dong, Songpa-gu, Seoul 138-736, Korea very slowly but appropriately. Her blood pressure was 130/74 Tel: 82-2-3010-3159, Fax: 82-2-486-5918 mm Hg, her pulse rate fluctuated from 30 to 78 beats/min, E-mail: [email protected] 102 Hyung Oh Choi, et al：Mental Change, Cardiovascular Depression and QT Prolongation Caused by Severe Hypermagnesemia 103 and her body temperature was 34.7oC. Laboratory data showed drowsy mental state showed no acute brain lesion. Calcium mild leukocytosis, azotemia, and hypokalemia. Abnormal labo- gluconate was given to antagonize the cardiovascular effects of ratory values were WBC 11700/mm3 (neutrophils, 87.3%), he- magnesium. moglobin 10.6 g/dl; BUN 71 mg/dl, serum creatinine 1.7 On hospital day 2, she was transferred to the intensive care mg/dl, sodium 132 mEq/dl, potassium 2.9 mEq/dl, chloride 84 unit for close monitoring and hemodialysis. Her pulse rate mEq/dl, calcium 7.6 mg/dl, phosphorus 5.2 mg/dl, and lactate fluctuated greatly from 35 to 125 beats/min and her BP drop- dehydrogenase 492 IU/L. Arterial blood gas analysis in room ped to 52/43 mm Hg during hemodialysis. She also showed air showed a pH of 7.450, pO2 82 mm Hg, pCO2 67.0 mm respiratory depression with a rate of 9 breaths/min. Inotropics Hg, HCO3 47.0 mEq/L, base excess 19.4 mEq/L, and O2 satu- were infused for hypotension. ECG showed nonsustained nar- ration 96%. The results were interpreted as indicative of mixed row QRS tachycardia alternating with slow junctional rhythm metabolic alkalosis and respiratory acidosis associated with (Fig. 1B). After hemodialysis, her serum magnesium concen- Bartter’s syndrome and respiratory depression. Considering her tration had decreased to 9.7 mg/dl. drug history, her serum magnesium concentration was measured On hospital day 3, she became fully conscious. Her magne- and found to be markedly elevated, to 16.19 mg/dl (reference, sium concentration decreased to 6.74 mg/dl, and an ECG 1.8−3.0 mg/dl). Initial ECG showed atrial bigeminy, frequent showed a sinus rhythm with QT prolongation and T wave APC, T wave inversion (II, III, aVF, and V4-6 lead), pro- inversion. Neither significant arrhythmias nor blood pressure longed QT interval (corrected QT: 545 msec), and first degree fluctuations were observed. On hospital day 12, her magnesium atrioventricular block (PR interval 218 msec) (Fig. 1A). Abdominal radiographs showed severe paralytic ileus. Computed tomography of the abdomen to rule out a hidden abnormality showed no evidence of any obstruction. Magnetic resonance imaging of the brain to evaluate her dysarthria and Fig. 2. On hospital day 12, the patient’s serum magnesium concentra- tion had decreased to 2.04 mg/dl. Electrocardiography showed near-normal findings. Fig. 1. Electrocardiography results. (A) On admission, various abnor- mal findings, such as prolonged PR interval, prolonged QTc interval, and frequent APC, were observed, associated with a magnesium concentration of 16.19 mg/dl. (B) On hospital day 2, serial rhythm strips of electrocardiography show atrial tachyarrhythmia alternating with prolonged sinus pause and slow junctional escape rhythm, associated with a magnesium Fig. 3. Schematic presentation of changes in electrolytes and prolonged concentration of 10.17 mg/dl. QTc. 104 대한중환자의학회지：제 23 권 제 2 호 2008 concentration had decreased to 2.04 mg/dl, her QT prolonga- QT interval.2,3,10) Our patient initially showed a prolonged PR tion and T wave inversion had returned to normal (Fig. 2), interval, prolonged QTc interval, and T wave inversion. Close and her serum creatinine concentration had normalized. Trans- monitoring revealed a rapidly changing arrhythmia of brady- thoracic echocardiography and thallium myocardial perfusion cardia, atrial tachyarrhythmia, and junctional rhythm (Fig. 1B). scan results were within normal limits. Fig. 3 shows that the markedly prolonged QT interval in our patient seemed to be caused mainly by hypermagnesemia, al- DISCUSSION though initially low potassium and calcium concentrations could have contributed to the QT prolongation. Torsades de Magnesium homeostasis is mainly dependent on gastro- pointes is uncommon in hypermagnesemia-induced QT pro- intestinal absorption and renal excretion, with the kidneys play- longation. This condition may be associated with the calcium ing a major role in magnesium regulation.1) Sixty to seventy blocking effect of hypermagnesemia per se. percent of filtered magnesium is reabsorbed mainly in the In conclusion, we describe a patient with severe, sympto- thick ascending limb of Henle.1,10) Because the kidneys can ex- matic, hypermagnesemia, arising after abuse of cathartics. This crete more than 6 g magnesium/day, severe hypermagnesemia finding suggests that hypermagnesemia could develop without usually develops in the presence of renal insufficiency.2) Our renal failure in patients with gastrointestinal disease. Hyper- patient had been diagnosed with Bartter’s syndrome. Because magnesemia should be suspected as a cause of mental change, this defect may be present in the thick ascending limb of cardiovascular dysfunction, and variable ECG changes. Henle's loop, renal magnesium wasting may occur in Bartter’s syndrome, in addition to hypokalemia, hypochloremic metabolic REFERENCES alkalosis, and decreased ability to concentrate and dilute urine.11) Her serum concentration of creatinine and BUN were ele- 1) Weisinger JR, Bellorin-Font E: Magnesium and phosphorus. vated at initial presentation but returned to normal ranges on Lancet 1998; 352: 391-6. hospital day 4, suggesting that the abnormality may have aris- 2)Gibbs MA, Tayal VS: Electrolyte disturbance. In: Rosen's en because of prerenal azotemia caused by hypotension and, emergency medicine: concepts and clinical practice. 6th ed. dehydration. Symptomatic hypermagnesemia has been reported Edited by John A, Marx M: Missouri, Mosby. 2006. Available form http://www.mdconsult.com/das/book/body/114504139-2/ in patients without renal failure, but with decreased gastro- 0/1365/382.html intestinal motility.3-7) This may occur after the ingestion of an- 3) Clark BA, Brown RS: Unsuspected morbid hypermagnesemia ticholinergics or narcotics or in patients with hypomotility dis- in elderly patients. Am J Nephrol 1992; 12: 336-43. orders such as chronic constipation, colitis, bowel obstruction, 4) Fassler CA, Rodriguez RM, Badesch DB, Stone WJ, Marini or gastric dilation.2) The symptomatic hypermagnesemia ob- JJ: Magnesium toxicity as a cause of hypotension and served in our patient may have been caused by gastrointestinal hypoventilation.
Load more

Recommended publications
  • Dysmagnesemia in Covid-19 Cohort Patients: Prevalence and Associated Factors
    Magnesium Research 2020; 33 (4): 114-122 ORIGINAL ARTICLE Dysmagnesemia in Covid-19 cohort patients: prevalence and associated factors Didier Quilliot1, Olivier Bonsack1, Roland Jaussaud2, Andre´ Mazur3 1 Transversal Nutrition Unit and; 2 Internal Medicine and Clinical Immunology. Nancy University Hospital, University of Lorraine, France; 3 Universite´ Clermont Auvergne, INRAE, UNH, Unite´ de Nutrition Humaine, Clermont-Ferrand, France Correspondence <[email protected]> Abstract. Hypomagnesemia and hypermagnesemia could have serious implications and possibly lead to progress from a mild form to a severe outcome of Covid-19. Susceptibility of subjects with low magnesium status to develop and enhance this infection is possible. There is little data on the magnesium status of patients with Covid-19 with different degrees of severity. This study was conducted to evaluate prevalence of dysmagnesemia in a prospective Covid-19 cohort study according to the severity of the clinical manifestations and to identify factors associated. Serum magnesium was measured in 300 of 549 patients admitted to the hospital due to severe Covid-19. According to the WHO guidelines, patients were classified as moderate, severe, or critical. 48% patients had a magnesemia below 0.75 mmol/L (defined as magnesium deficiency) including 13% with a marked hypomagnesemia (<0.65 mmol/L). 9.6% had values equal to or higher than 0.95 mmol/L. Serum magnesium concentrations were significantly lower in female than in male (0.73 Æ 0.12 vs 0.80 Æ 0.13 mmol/L), whereas the sex ratio M/F was higher in severe and critical form (p<0.001). In a bivariate analysis, the risk of magnesium deficiency was significantly and negatively associated with infection severity (p<0.001), sex ratio (M/F, p<0.001), oxygenotherapy (p<0.001), stay in critical care unit (p=0.028), and positively with nephropathy (p=0.026).
    [Show full text]
  • Increased Mortality Associated with Hypermagnesemia in Severe COVID-19 Illness
    Original Investigation Increased Mortality Associated with Hypermagnesemia in Severe COVID-19 Illness Jacob S. Stevens 1,2, Andrew A. Moses1, Thomas L. Nickolas1,2, Syed Ali Husain1,2, and Sumit Mohan1,2,3 Key Points Hypermagnesemia is common in patients admitted with coronavirus disease 2019. The development of hypermagnesemia in coronavirus disease 2019 is associated with renal failure and markers of high cell turnover. In adjusted models, patients who develop hypermagnesemia have an increased risk of mortality. Abstract Background Although electrolyte abnormalities are common among patients with COVID-19, very little has been reported on magnesium homeostasis in these patients. Here we report the incidence of hypermagnesemia, and its association with outcomes among patients admitted with COVID-19. Methods We retrospectively identified all patients with a positive test result for SARS-CoV-2who were admitted to a large quaternary care center in New York City in spring 2020. Details of the patients’ demographics and hospital course were obtained retrospectively from medical records. Patients were defined as having hypermagnesemia if their median magnesium over the course of their hospitalization was .2.4 mg/dl. Results A total of 1685 patients hospitalized with COVID-19 had their magnesium levels checked during their hospitalization, and were included in the final study cohort, among whom 355 (21%) had hypermagnesemia. Patients who were hypermagnesemic had a higher incidence of shock requiring pressors (35% vs 27%, P,0.01), respiratory failure requiring mechanical ventilation (28% vs 21%, P50.01), AKI (65% vs 50%, P,0.001), and AKI severe enough to require renal replacement therapy (18% vs 5%, P,0.001).
    [Show full text]
  • Early-Onset Neonatal Hyperkalemia Associated with Maternal
    Tanaka et al. BMC Pediatrics (2018) 18:55 https://doi.org/10.1186/s12887-018-1048-4 CASEREPORT Open Access Early-onset neonatal hyperkalemia associated with maternal hypermagnesemia: a case report Kenichi Tanaka1, Hiroko Mori1, Rieko Sakamoto2, Shirou Matsumoto2, Hiroshi Mitsubuchi1, Kimitoshi Nakamura2 and Masanori Iwai1* Abstract Background: Neonatal nonoliguric hyperkalemia (NOHK) is a metabolic abnormality that occurs in extremely premature neonates at approximately 24 h after birth and is mainly due to the immature functioning of the sodium (Na+)/potassium (K+) pump. Magnesium sulfate is frequently used in obstetrical practice to prevent preterm labor and to treat preeclampsia; this medication can also cause hypermagnesemia and hyperkalemia by a mechanism that is different from that of NOHK. Herein, we report the first case of very early-onset neonatal hyperkalemia induced by maternal hypermagnesemia. Case presentation: A neonate born at 32 weeks of gestation developed hyperkalemia (K+ 6.4 mmol/L) 2 h after birth. The neonate’s blood potassium concentration reached 7.0 mmol/L 4 h after birth, despite good urine output. The neonate and his mother had severe hypermagnesemia caused by intravenous infusion of magnesium sulfate given for tocolysis due to pre-term labor. Conclusion: The early-onset hyperkalemia may have been caused by the accumulation of potassium ions transported through the placenta, the shift of potassium ions from the intracellular to the extracellular space in the infant due to the malfunctioning of the Na+/K+ pump and the inhibition of renal distal tube potassium ion secretion, there is a possibility that these mechanisms were induced by maternal and fetal hypermagnesemia after maternal magnesium sulfate administration.
    [Show full text]
  • Electrolyte Disorders and Arrhythmogenesis
    Cardiology Journal 2011, Vol. 18, No. 3, pp. 233–245 Copyright © 2011 Via Medica REVIEW ARTICLE ISSN 1897–5593 Electrolyte disorders and arrhythmogenesis Nabil El-Sherif1, Gioia Turitto2 1State University of NY, Downstate Medical Center and NY Harbor VA Healthcare System, Brooklyn, NY, USA 2Methodist University Hospital, Brooklyn, NY, USA Abstract Electrolyte disorders can alter cardiac ionic currents kinetics and depending on the changes can promote proarrhythmic or antiarrhythmic effects. The present report reviews the mecha- nisms, electrophysiolgical (EP), electrocardiographic (ECG), and clinical consequences of elec- trolyte disorders. Potassium (K+) is the most abundent intracellular cation and hypokalemia is the most commont electrolyte abnormality encountered in clinical practice. The most signifcant ECG manifestation of hypokalemia is a prominent U wave. Several cardiac and + non cardiac drugs are known to suppress the HERG K channel and hence the IK, and especially in the presence of hypokalemia, can result in prolonged action potential duration and QT interval, QTU alternans, early afterdepolarizations, and torsade de pointes ventricu- lar tachyarrythmia (TdP VT). Hyperkalemia affects up to 8% of hospitalized patients mainly in the setting of compromised renal function. The ECG manifestation of hyperkalemia de- pends on serum K+ level. At 5.5–7.0 mmol/L K+, tall peaked, narrow-based T waves are seen. At > 10.0 mmol/L K+, sinus arrest, marked intraventricular conduction delay, ventricular techycardia, and ventricular fibrillation can develop. Isolated abnormalities of extracellular calcium (Ca++) produce clinically significant EP effects only when they are extreme in either direction. Hypocalcemia, frequently seen in the setting of chronic renal insufficiency, results in prolonged ST segment and QT interval while hypercalcemia, usually seen with hyperparathy- roidism, results in shortening of both intervals.
    [Show full text]
  • Front Matter (PDF)
    HIGH RATE OF SUCCESS IN AN NIH- STUDY of hypertensive patients- highest percentage - remained on itial therapy 83% with NORVASC#{174}(amlodipi besylate) after 4 years; nearly all pati were on the 5-mg starting dose’ LOW RATE DISCONTINUATION ONLY 1.5%of patients in placebo studies (n= 1730) discontinued due to adverse effects2 PROVEN No negative inotropic effects clinical doses in hemodyna m ic stud 2* No clinically significant effect on cardiac conduction or heart rate2 *S1IflH,jr fiernodynamic findings, hcvever fiave been agents possessing significant neqafive notropic ebecto and 10-mg tablets Once-Daily NORV (ambdipine EFFICACY AND SAFETY THAT’S EASY TO WITH Br$e(Summary NORVASC(amlodlpine besylate) Tablets For Oral Use CONTRAINDICATIONS: NORVASC is contraindicated in patients with known sensitivity to arniodipirre. In hypertension WARNINGS: Increased Angina and/or MyOcardIal Infarction: Rarely, patients, particulady those with severe obstruc5ve coronary artery disease, have developed documented increased frequency,durationand/or severity of angina or acute myocardial infarction on starhng cafrium channel blocker therapy or attire time of dosage increase. The mechanism of this effect has not been elucidated. PRECAUTIONS: General: Since the vasoditation induced by NORVASC is gradual in onset, acute hypotension has rarely been reported after oraladministrationof NORVASC. Nonethetuss, caution should be exercised when admin- or angina, convenient istering NORVASC as with any other penpherio vasodilator particularly in pahentswithsevere
    [Show full text]
  • Women'shealthreport
    Issue 4, 2014 Women’sHealthREPORT A QuaRTERLY PubLicatiON OF WOMEN’S HEALth diETEtic PRacticE GROup MICRONUTRIENTS AND THE OLDER ADULT – Part 1: Micronutrients of Importance to Older Adults By Vijaya Jain, MS, MSc, RD, CDN among older adults. A decreased energy intake associated with advancing age has important implications in terms of nutrient intake among older adults, including protein and micronutrients. Suboptimal intake for several micronutrients is prevalent among older adults. INTRODUCTION Increasing life expectancy has led to a steady rise in the number of older persons globally. In 2012, the number of older Americans aged 65 years and older had reached 43.1 million (1). As many of these older Americans continue to remain healthy and active well into their eighties and even nineties, and have better medi- cal management of chronic diseases and their comorbidities, the size of the older population is projected to double between 2000 and 2030 (2). According to the US Bureau of the Census, the size of the population age 85 and over is projected to be 7 Note from Chair: Collaboration is essential to the success of both million by 2020 (1). The baby-boomer generation will reach age individuals and organizations. It is has been a personal goal of mine 65 between 2010 and 2030, meaning that by 2030, one in five to see the Women’s Health DPG work with other DPGs and related American citizens will be older adults (1), and two out of every health organizations. In recent years, we have enhanced our mission three older Americans will have multiple chronic conditions (3).
    [Show full text]
  • Rhode Island Chapter Abstracts
    Rhode Island Chapter Abstracts April 1, 2015 Abdin, Ahmad Last Name: Abdin First Author: Resident First Name: Ahmad Category: Clinical Vignette PG Year: PGY-1 or MS Year: ACP Number: 2888549 Medical School or Residency Program: Warren Alpert Medical School of Brown University Hospital Affiliation: Memorial Hospital of Rhode Island, Providence VA Medical Center Additional Authors: Ahmad Abdin, MD, Mohammed Salhab, MD, Amos Charles, MD, Mazen Al-Qadi, MD Abstract Title: Amiodarone-Induced Cerebellar Dysfunction Abstract Text: Introduction: Amiodarone is a class III antiarrhythmic agent that is widely used to treat ventricular and supraventricular tachycardias. Several side-effects of the drug have been recognized including thyroid dysfunction, photosensitivity, hepatotoxicity, parenchymal lung disease, corneal deposits, and peripheral neuropathy. Cerebellar dysfunction is rarely seen in patients receiving amiodarone. We are reporting a rare case of amiodarone-induced cerebellar dysfunction that resolved completely upon discontinuation of the drug. Case Presentation: A 73-year-old man with a past medical history significant for paroxysmal atrial fibrillation, coronary artery disease, diabetes and hypertension who presented with worsening lower extremity weakness and unsteady gait with recurrent falls for the last 6 months. Two days prior to admission, his symptoms got worse and caused him to seek medical attention. Two years ago he was started and maintained on amiodarone 200 mg daily for rhythm control. On physical examination, vital signs were normal. A wide-based unsteady gait was noted. He had dysmetria bilaterally on finger-to-nose and heel-to-shin testing. The rapid alternating movements of the hands were irregular. The remainder of the general and neurologic examinations were unremarkable.
    [Show full text]
  • Nutrition Journal of Parenteral and Enteral
    Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/ Micronutrient Supplementation in Adult Nutrition Therapy: Practical Considerations Krishnan Sriram and Vassyl A. Lonchyna JPEN J Parenter Enteral Nutr 2009 33: 548 originally published online 19 May 2009 DOI: 10.1177/0148607108328470 The online version of this article can be found at: http://pen.sagepub.com/content/33/5/548 Published by: http://www.sagepublications.com On behalf of: The American Society for Parenteral & Enteral Nutrition Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> Version of Record - Aug 27, 2009 OnlineFirst Version of Record - May 19, 2009 What is This? Downloaded from pen.sagepub.com by Karrie Derenski on April 1, 2013 Review Journal of Parenteral and Enteral Nutrition Volume 33 Number 5 September/October 2009 548-562 Micronutrient Supplementation in © 2009 American Society for Parenteral and Enteral Nutrition 10.1177/0148607108328470 Adult Nutrition Therapy: http://jpen.sagepub.com hosted at Practical Considerations http://online.sagepub.com Krishnan Sriram, MD, FRCS(C) FACS1; and Vassyl A. Lonchyna, MD, FACS2 Financial disclosure: none declared. Preexisting micronutrient (vitamins and trace elements) defi- for selenium (Se) and zinc (Zn). In practice, a multivitamin ciencies are often present in hospitalized patients. Deficiencies preparation and a multiple trace element admixture (containing occur due to inadequate or inappropriate administration, Zn, Se, copper, chromium, and manganese) are added to par- increased or altered requirements, and increased losses, affect- enteral nutrition formulations.
    [Show full text]
  • Severe Hypermagnesemia Presenting with Abnormal Electrocardiographic Findings Similar to Those of Hyperkalemia in a Child Undergoing Peritoneal Dialysis
    Case report Korean J Pediatr 2013;56(7):308-311 http://dx.doi.org/10.3345/kjp.2013.56.7.308 pISSN 1738-1061•eISSN 2092-7258 Korean J Pediatr Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis Won Kyoung Jhang, MD, PhD, Yoon Jung Lee, MD, Young A Kim, MD, Seong Jong Park, MD, PhD, Young Seo Park, MD, PhD Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea In this report, we present a pediatric case of severe symptomatic hypermagnesemia resulting from Corresponding author: Young Seo Park, MD, PhD the use of magnesium oxide as a laxative in a child undergoing continuous cyclic peritoneal dialysis for Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of end-stage renal disease. The patient showed abnormal electrocardiography (ECG) findings, such as Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul tall T waves, a widened QRS complex, and irregular conduction, which were initially misdiagnosed as 138-736, Korea hyperkalemia; later, the correct diagnosis of hypermagnesemia was obtained. Emergent hemodialysis Tel: +82-2-3010-3376, Fax: +82-2-473-3725 successfully returned the serum magnesium concentration to normal without complications. When E-mail: [email protected] abnormal ECG changes are detected in patients with renal failure, hypermagnesemia should be considered. Received: 3 December, 2011 Revised: 17 April, 2012 Key words: Magnesium, Peritoneal dialysis, Hyperkalemia Accepted: 12 July, 2012 Introduction Hypermagnesemia is an uncommon clinical condition. Symptomatic hypermagnesemia usually occurs in elderly individuals and in patients with bowel disorders or renal insuffi­ ciency in the setting of excessive magnesium ingestion1­5).
    [Show full text]
  • Hypercalcemia
    Hypercalcemia Dr. Andrés Pérez Riera Causes: Hypercalcemia is divided into PTH-mediated hypercalcemia (primary hyperparathyroidism) and non–PTH-mediated hypercalcemia. 1) PTH-mediated hypercalcemia is related to increased calcium absorption from the intestine. 2) Non–PTH-mediated hypercalcemia includes the following: (2.1) Hypercalcemia associated with malignancy: Unlike PTH-mediated hypercalcemia, the elevation of calcium that results from malignancy generally worsens until therapy is provided. Hypercalcemia caused by malignancy is the result of increased osteoclastic activity within the bone. This results from one or both of the mechanisms that follow: (2.1-a) Extensive localized bone destruction may result from osteolytic metastasis of solid tumors. Evidence indicates that many malignant cells may release local osteoclastic activating factors. (2.1-b) Increased calcium levels resulting from malignancy caused by a PTH- related protein is a second mechanism. This protein is a humeral factor that acts on the skeleton to increase bone reabsorption; it acts on the kidney to decrease excretion of calcium. The gene that produces this protein is present in many malignant tissues. (2.2) Granulomatous disorders: High levels of calcitriol may be found in patients with sarcoidosis and other granulomatous diseases. In these disorders, the increased level of calcitriol results from production within the macrophages, which constitute a large portion of some granulomas. (2.3) Iatrogenic: In some cases, elevation of calcium is a known adverse effect of appropriate dosage. In other cases, large ingestions must be taken to induce the increase in calcium levels. Obtain a complete review of current medications for patients presenting with hypercalcemia. Record any vitamin use.
    [Show full text]
  • 2003 Birmingham
    11 S1 The Advanced DNA Banking and European Journal of Human Genetics Isolation Technology – IsoCode® IsoCode is optimized lyse Cells IsoCode is available To isolate DNA Standard Card and Stix archive DNA As ID with colour indicator prepare PCR IsoCode can be used high through-put format identification of individuals you want For population screening forensic testing paternity testing • Supplement 11 1 Volume Archiving DNA, cDNA Clones and Vectors The Official Journal of the European Society of Human Genetics Biological samples dried on IsoCode can be archived indefinitely at ambi- ent temperatures. IsoCode is bactericidal, virucidal, and fungicidal. Isolation of DNA without any reagents EUROPEAN HUMAN GENETICS CONFERENCE 2003 IsoCode binds and inactivates proteins and inhibitors – but not the DNA . DNA is released from IsoCode in a simple water elution process that MAY 3 – 6, 2003, BIRMINGHAM, ENGLAND requires neither reagents nor additional costs. PROGRAMME AND ABSTRACTS High quality DNA – easy and cheap DNA eluted from IsoCode is ready for PCR, automated DNA sequencing, STR analysis, mtDNA analysis and other bio-molecular techniques. Use in a lot of fields May 2003 Ideal for drug discovery SNP libraries, epide- miological studies, human identity appli- cations, forensic samples and as back-up copy. EHGC 2003 Booth 940 Volume 11 – Supplement 1 – May 2003 U.S. Pat. #5.939.259, U.S. Pat. 6.168.922 Made under license from Whatman plc. to U.S. Pat. #5.807.527 Schleicher & Schuell BioScience GmbH · Tel. +49-55 61-79 14 63 · Fax +49-55 61-79 15 83 · D-37582 Dassel · Germany · [email protected] Schleicher & Schuell BioScience Inc.
    [Show full text]
  • Increased Mortality Associated with Hypermagnesemia in Severe COVID-19 Illness
    Kidney360 Publish Ahead of Print, published on May 17, 2021 as doi:10.34067/KID.0002592021 Increased mortality associated with hypermagnesemia in severe COVID-19 illness Jacob S. Stevens*1,2, Andrew A. Moses1, Thomas L. Nickolas1,2, S. Ali Husain1,2, Sumit Mohan1,2,3 1. Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY. 2. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY. 3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. *Corresponding author – email: [email protected] Jacob S. Stevens, MD Columbia University Irving Medical Center New York, New York United States 1 Copyright 2021 by American Society of Nephrology. Key Points Hypermagnesemia is common in patients admitted with COVID-19 illness The development of hypermagnesemia in COVID-19 is associated with renal failure and markers of high cell turnover In adjusted models, patients who develop hypermagnesemia have an increased risk of mortality Abstract Background While electrolyte abnormalities are common among patients with COVID-19, very little has been reported on magnesium homeostasis in these patients. Here we report the incidence of hypermagnesemia and its association with outcomes among patients admitted with COVID-19. Methods We retrospectively identified all patients with a positive test result for SARS-CoV-2 who were admitted to a large quaternary care center in New York City in spring 2020. Details of the patients’ demographics and hospital course were obtained retrospectively from the medical record. Patients were defined as having hypermagnesemia if their median magnesium over the course of their hospitalization was >2.4 mg/dL.
    [Show full text]