Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/07 14:41:20」(JST)

wiki en

Hypermagnesemia is an electrolyte disturbance in which there is an abnormally elevated level of magnesium in the blood.^[1] Usually this results in excess of magnesium in the body.

Hypermagnesemia occurs rarely because the kidney is very effective in excreting excess magnesium. It usually develops only in people with renal failure who are given magnesium salts or who take drugs that contain magnesium (e.g. some antacids and laxatives). It is usually concurrent with hypocalcemia and/or hyperkalemia.

Metabolism[edit]

For a detailed description of magnesium homeostasis and metabolism see hypomagnesemia.

Symptoms[edit]

Weakness, nausea and vomiting
Impaired breathing
Decreased respirations
Hypotension
Hypocalcemia
Arrhythmia and Asystole
Decreased or absent deep tendon reflexes
Bradycardia

Arrhythmia and asystole are possible cardiac complications of hypermagnesemia. Magnesium acts as physiologic calcium blocker, which results in electrical conduction abnormalities.

Clinical consequences related to serum concentration:

4.0 mEq/l hyporeflexia
>5.0 mEq/l Prolonged atrioventricular conduction
>10.0 mEq/l Complete heart block
>13.0 mEq/l Cardiac arrest

Note that the therapeutic range for the prevention of the pre-eclampsic uterine contractions is: 4.0-7.0 mEq/L.^[2] As per Lu and Nightingale,^[3] serum Mg²⁺ concentrations associated with maternal toxicity (also neonate depression - hypotonia and low Apgar scores) are:

7.0-10.0 mEq/L - loss of patellar reflex
10.0-13.0 mEq/L - respiratory depression
15.0-25.0 mEq/L - altered atrioventricular conduction and (further) complete heart block
>25.0 mEq/L - cardiac arrest

Hypermagnesemia in renal failure[edit]

An evaluation of 515 patients on hemodialysis demonstrated that serum magnesium concentration lower than 2.77 mg/dL (1.14 mmol/L) is a significant predictor for increased all-cause mortality. While the mean serum magnesium concentration of this study population (2.77 mg/dL or 1.14 mmol/L) would be considered indicative of mild hypermagnesemia in the healthy population, serum magnesium concentrations in hemodialysis patients may be optimal at a higher concentration, in view of better survival under hemodialysis conditions, without causing severe and symptomatic hypermagnesemia.^[4] Consistently, lower magnesium levels were significantly associated with the presence of vascular calcification of the hand arteries in a study investigating 390 nondiabetic hemodialysis patients. These results suggest that higher serum magnesium concentrations may play an important protective role in the development of vascular calcification in hemodialysis patients.^[5] Results from a longitudinal study with end-stage renal disease patients suggest that hypermagnesemia may retard the development of arterial calcifications in end-stage renal disease.^[6] Significantly lower values of carotid intima-media thickness and aortic pulse wave velocity values, which are surrogate markers for vascular calcification, were observed in chronic kidney disease patients with high serum magnesium levels (0.90-1.32 mmol/L or 2.18-3.21 mg/dL) indicating a lower arteriosclerotic burden associated with a lower risk of cardiovascular events and mortality.^[7] Consequently, CKD patients with mildly elevated magnesium levels could have a survival advantage over those with lower magnesium levels.^[8]

Causes[edit]

Magnesium status depends on three organs: uptake in the intestine, storage in the bone and excretion in the kidneys. Hypermagnesemia is therefore often due to problems in these organs, mostly intestine or kidney.^[9]

Predisposing conditions[edit]

Haemolysis, magnesium concentration in erythrocytes is approximately three times greater than in serum, therefore hemolysis can increase plasma magnesium. Hypermagnesemia is expected only in massive hemolysis.
Renal insufficiency, excretion of magnesium becomes impaired when creatinine clearance falls below 30 ml/min. However, hypermagnesemia is not a prominent feature of renal insufficiency unless magnesium intake is increased.
Other conditions that can predispose to mild hypermagnesemia are diabetic ketoacidosis, adrenal insufficiency, hyperparathyroidism and lithium intoxication.

Therapy[edit]

Prevention of hypermagnesemia usually is possible. In mild cases, withdrawing magnesium supplementation is often sufficient. In more severe cases the following treatments are used:

Intravenous calcium gluconate, because the actions of magnesium in neuromuscular and cardiac function are antagonized by calcium.

Definitive treatment of hypermagnesemia requires increasing renal magnesium excretion through:

Intravenous diuretics, in the presence of normal renal function
Dialysis, when kidney function is impaired and the patient is symptomatic from hypermagnesemia

References[edit]

^ "hypermagnesemia" at Dorland's Medical Dictionary
^ Pritchard JA. The use of the magnesium ion in the management of eclamptogenic toxemias. Surg Gynecol Obstet. 1955; 100:131–140
^ Lu JF,Nightingale CH. Magnesium sulfate in eclampsia and pre-eclampsia. Clin Pharmacokinet. 2000; 38:305–314
^ Ishimura E, Okuno S, Yamakawa T et al. (2007). "Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients". Magnes Res 20: 237–244. doi:10.1684/mrh.2007.0116. PMID 18271493.
^ Ishimura E, Okuno S, Kitatani K et al. (2007). "Significant association between the presence of peripheral vascular calcification and lower serum magnesium in hemodialysis patients". Clin Nephrol 68: 222–227. PMID 17969489.
^ Meema HE, Oreopoulos DG, Rapoport A. (1987). "Serum magnesium level and arterial calcification in end-stage renal disease". Kidney Int 32: 388–394. PMID 3669498.
^ Salem S, Bruck H, Bahlmann FH et al. (2012). "Relationship between magnesium and clinical biomarkers on inhibition of vascular calcification". Am J Nephrol 35: 31–39. doi:10.1159/000334742. PMID 22179063.
^ Massy ZA, Drüeke TB (2012). "Magnesium and outcomes in patients with chronic kidney disease: focus on vascular calcification, atherosclerosis, and survival". Clin Kidney J 5 (Suppl 1): i52–i61. doi:10.1093/ndtplus/sfr167.
^ Jahnen-Dechent W, Ketteler M (2012). "Magnesium basics". Clin Kidney J 5 (Suppl 1): i3–i14. doi:10.1093/ndtplus/sfr163.

External links[edit]

BJMU: Causes and treatment of hypermagnesemia
Magnesium – a versatile and often overlooked element: new perspectives with a focus on chronic kidney disease

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 高マグネシウム血症の原因および治療 causes and treatment of hypermagnesemia
2. 高マグネシウム血症の症状 symptoms of hypermagnesemia
3. 神経筋接合部に作用する毒素の概要 overview of neuromuscular junction toxins
4. 新生児および幼児における神経筋接合部障害 neuromuscular junction disorders in newborns and infants
5. マグネシウムバランスの調節 regulation of magnesium balance

English Journal

Admission serum magnesium levels and the risk of acute respiratory failure.

Thongprayoon C1,2, Cheungpasitporn W1, Srivali N2, Erickson SB1.
International journal of clinical practice.Int J Clin Pract.2015 Nov;69(11):1303-8. doi: 10.1111/ijcp.12696. Epub 2015 Jul 21.
BACKGROUND: The association between admission serum magnesium (Mg) levels and risk of acute respiratory failure (ARF) in hospitalised patients is limited. The aim of this study was to assess the risk of developing ARF in all hospitalised patients with various admission Mg levels.METHODS: This is a s
PMID 26205345

Pathophysiology of Calcium, Phosphorus, and Magnesium Dysregulation in Chronic Kidney Disease.

Felsenfeld AJ1, Levine BS1, Rodriguez M2.
Seminars in dialysis.Semin Dial.2015 Nov;28(6):564-77. doi: 10.1111/sdi.12411. Epub 2015 Aug 25.
Calcium, phosphorus, and magnesium homeostasis is altered in chronic kidney disease (CKD). Hypocalcemia, hyperphosphatemia, and hypermagnesemia are not seen until advanced CKD because adaptations develop. Increased parathyroid hormone (PTH) secretion maintains serum calcium normal by increasing calc
PMID 26303319

Serum Magnesium Status in Patients Subjects with Depression in the City of Yazd in Iran 2013-2014.

Rajizadeh A1, Mozaffari-Khosravi H2, Yassini-Ardakani M3, Dehghani A4.
Biological trace element research.Biol Trace Elem Res.2015 Oct 21. [Epub ahead of print]
Depression is the most common mental disorder and involves many factors. The regulatory effects of magnesium on N-methyl-D-aspartate (NMDA) channels make it a factor in the treatment of depression. The present study investigated the level of serum magnesium in subjects diagnosed with depression in t
PMID 26487446

Japanese Journal

今月の症例急性腎障害により意識障害を呈する高マグネシウム血症を発症した1例

久田温子,鈴木仁,村越真紀 [他]
日本内科学会雑誌 101(12), 3513-3515, 2012-12-10
NAID 40019553312

緩和ケア病棟入院中の患者における血清マグネシウム値について

片山英樹,青江啓介,関千尋,阿部宏美,三村雄輔,上岡博
Palliative Care Research 7(2), 202-208, 2012
緩和ケア病棟へ入院中の進行がん患者48名の血清マグネシウム値を測定し, マグネシウム製剤の内服の有無や全身状態とその臨床的意義を検討した. 血清マグネシウムの平均値は2.09 mg/dlであり, マグネシウム製剤投与例の平均値は2.17 mg/dlと, マグネシウム製剤非投与例の平均値1.80 mg/dlに比べて有意に高値であった(p=0.006). 基準値(1.8～2.8 mg/dl)を外れた高 …
NAID 130002084778

A case of cardiopulmonary arrest caused by laxatives-induced hypermagnesemia in a patient with anorexia nervosa and chronic renal failure

TATSUMI Hiroomi,MASUDA Yoshiki,IMAIZUMI Hitoshi,KURODA Hiromitsu,YOSHIDA Shin-ichiro,KYAN Ryoko,GOTO Kyoko,ASAI Yasufumi
Journal of anesthesia 25(6), 935-938, 2011-12-20
NAID 10030449137

Related Pictures

★リンクテーブル★

リンク元	「高マグネシウム血症」

「高マグネシウム血症」

Hypermagnesemia
	Classification and external resources
	; Magnesium
ICD-10	E83.4
ICD-9	275.2
DiseasesDB	6259
eMedicine	med/3383 emerg/262 ped/1080

　　[★]

英: hypermagnesemia
同: 高Mg血症
関: マグネシウム、低マグネシウム血症、電解質異常

定義

血清マグネシウム 2.7mg/dL以上(1.11mEq/L)

2.305 mg/dL = 1mEq/L (∵　Mg 24.305g/mol)

症状

循環器症状：徐脈・起立性低血圧
精神・神経・筋症状：筋力や腱反射低下、傾眠
消化器症状：嘔気・嘔吐

血清マグネシウム濃度と症状

反射低下：＞4mEq/L
I度房室ブロック：＞5mEq/L
完全房室ブロック：＞10mEq/L
心停止：＞13mEq/L

症状 - 持田製薬販売株式会社

http://www.mochida.co.jp/dis/tekisei/mag2710.pdf

血中Mg濃度	症状
4.9mg/dL～	悪心・嘔吐、起立性低血圧、徐脈、皮膚潮紅、筋力低下、傾眠、全身倦怠感、無気力、腱反射の減弱など
6.1～12.2mg/dL	ECG異常（PR、QT延長）など
9.7mg/dL～	腱反射消失、随意筋麻痺、嚥下障害、房室ブロック、低血圧など
18.2mg/dL～	昏睡、呼吸筋麻痺、血圧低下、心停止など

治療

WMM.89

支持療法：人工呼吸、体外式ペースメーカー
内科療法：

(腎機能正常)グルコン酸カルシウム(CaはMgに拮抗して腎らの排泄をうながす)、輸液(Mgの排泄を促す)
(腎不全)透析

[1] "hypermagnesemia" at Dorland's Medical Dictionary

[2] Pritchard JA. The use of the magnesium ion in the management of eclamptogenic toxemias. Surg Gynecol Obstet. 1955; 100:131–140

[3] Lu JF,Nightingale CH. Magnesium sulfate in eclampsia and pre-eclampsia. Clin Pharmacokinet. 2000; 38:305–314

[Ishimura2007-4] Ishimura E, Okuno S, Yamakawa T et al. (2007). "Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients". Magnes Res 20: 237–244. doi:10.1684/mrh.2007.0116. PMID 18271493.

[Ishimura2007a-5] Ishimura E, Okuno S, Kitatani K et al. (2007). "Significant association between the presence of peripheral vascular calcification and lower serum magnesium in hemodialysis patients". Clin Nephrol 68: 222–227. PMID 17969489.

[Meema1987-6] Meema HE, Oreopoulos DG, Rapoport A. (1987). "Serum magnesium level and arterial calcification in end-stage renal disease". Kidney Int 32: 388–394. PMID 3669498.

[Salem2012-7] Salem S, Bruck H, Bahlmann FH et al. (2012). "Relationship between magnesium and clinical biomarkers on inhibition of vascular calcification". Am J Nephrol 35: 31–39. doi:10.1159/000334742. PMID 22179063.

[Massy2012-8] Massy ZA, Drüeke TB (2012). "Magnesium and outcomes in patients with chronic kidney disease: focus on vascular calcification, atherosclerosis, and survival". Clin Kidney J 5 (Suppl 1): i52–i61. doi:10.1093/ndtplus/sfr167.

[Jahnen-Dechent2012-9] Jahnen-Dechent W, Ketteler M (2012). "Magnesium basics". Clin Kidney J 5 (Suppl 1): i3–i14. doi:10.1093/ndtplus/sfr163.

匿名

検索

案内

案内

hypermagnesemia