Acute hypermagnesemia in a child

Fatal Hypermagnesemia Due to Laxative Use

We report a case of fatal hypermagnesemia in a 53-year-old woman admitted for acute exacerbation of chronic obstructive pulmonary disease and with a history of chronic constipation treated regularly with magnesium-containing laxatives. On admission, her magnesium level was 2.0mg/dL, which rose to a peak of 10.8mg/dL despite hydration and diuresis in the presence of a normal kidney function. Continuous renal replacement therapy was promptly initiated, which reduced her serum magnesium levels, but her condition continued to deteriorate precipitously progressing to shock leading to oligoanuric renal failure, and she died 2 days later. A review of the literature shows that though rare and often unsuspected, severe hypermagnesemia frequently results in death even in individuals with normal renal function despite renal replacement therapy. In patients with constipation, retention of magnesium-based laxative in the gut apparently serves as a reservoir for continuous magnesium absorption and contributes to mortality.

Correlation of magnesium levels in cord blood and maternal serum among pre-eclamptic pregnant women treated with magnesium sulfate

AIM

The aim of this study was to determine the correlation between cord blood and maternal serum magnesium levels among pre-eclamptic pregnant women treated with magnesium sulfate.

MATERIALS AND METHODS

A total of 36 pregnant women, >28weeks' gestation, diagnosed with pre-eclampsia and treated with magnesium sulfate (MgSO(4) ), were enrolled. Maternal and umbilical cord blood samples were obtained immediately after delivery and sent for determination of magnesium and calcium levels.

RESULTS

  Mean maternal age was 27.4±6.4years and mean gestational age was 38.1±1.8weeks. Most were diagnosed with pre-eclampsia (94.5%), others had HELLP syndrome. Mean total MgSO(4) the women received was 14.4±6.0g and mean duration of treatment was 5.1±3.3h. Mean maternal serum and cord blood magnesium levels were 2.2±0.4 and 1.8±0.3mmol/L, respectively. Maternal magnesium and calcium levels showed significant positive correlation with their levels in cord blood (P<0.001). Significant positive correlation was found between total dose as well as duration of MgSO4 and maternal and cord blood magnesium levels (P<0.001) but was inversely correlated with maternal and cord blood calcium levels.

CONCLUSIONS

Maternal serum magnesium and calcium levels were correlated with cord blood levels in pre-eclamptic pregnant women who received MgSO4 therapy.