Hypermagnesemia is often an under reported finding in critically ill patients with cancer. Hypomagnesemia is a commonly encountered electrolyte abnormality in patients with cancer that is primarily caused by a reduced intake, secondary to chemotherapeutic drugs and malnutrition. Hypermagnesemia is rarely observed in patients with normal renal function, as excess intake can be compensated by renal excretion. However, in critically ill patients with reduced renal function, hypermagnesemia can add further to complications and increase mortality. Drugs such as lactulose, antacids, fentanyl and peptide hormones, including vasopressin, can further increase chances of hypermagnesemia, particularly when patients demonstrate decreased renal function and multiple organ failure. Prudence and caution must therefore be exercised while using these agents in critically ill patients with cancer to avoid increased complications and mortality. Herein, the current study reports three cases of critically ill patients with cancer admitted into intensive care who had refractory hypermagnesemia.

Here we report a case of Sepsis mimicking as thrombotic thrombocytopenic purpura in a cancer patient with Urothelioma. A 61-year-old man with High grade Urothelial Carcinoma of left renal pelvis (Multifocal disease) Stage-4 presented with Fever on and off since 1 week and shortness of breath at rest since 2 days and hematuria since 1 day.Later in the course, he developed thrombocytopenia followed by MAHA (Micro Angiopathic haemolytic Anaemia), and other lab abnormalities .Thrombotic thrombocytopenic purpura (TTP) was suspected, and total plasma exchange was considered. Since serum procalcitonin,Total leucocyte count was very high and also had elevated prothrombin time, ADAMTS13(a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13) was sent for confirmation showed that ADAMTS13 activity of more than 10% for which plasmapheresis was delayed , later patient was treated for sepsis , but patient did not respond and succumbed . This case shows that Sepsis can mimic TTP making diagnosis and treatment extremely difficult. In this type of clinical dilemma to do total plasma exchange (TPE) which is the main modality of treatment for TTP ADAMTS13 activity helps us to prioritise treatment