Iatrogenic magnesium toxicity following intravenous infusion of magnesium sulfate: risks and strategies for prevention

Abstract

SUMMARYA 65-year-old man being treated with radiotherapy and chemotherapy for recurrent colonic adenocarcinoma was admitted for management of hypokalaemia and hypomagnesaemia secondary to diarrhoea. He was treated with intravenous infusions of potassium chloride and magnesium sulfate. Following an infusion of magnesium sulfate, he experienced a sudden neurological deterioration. A CT of the head revealed no haemorrhage or evidence of acute ischaemic injury. Results of serum biochemistry later that day revealed an elevated magnesium level. Iatrogenic magnesium toxicity was suspected. Further discussions between the pharmacist and ward staff confirmed that a medication error had been made in the preparation of the infusion resulting in an overdose of intravenous magnesium. BACKGROUND

Magnesium Toxicity Presented as Quadriparesis in Postpartum Period: Case Report

“…If untreated, respiratory failure results from respiratory muscle involvement. The muscle weakness is typically flaccid type, and it is caused by blockage of neuromuscular transmission, which resolves only when the magnesium level returns to normal [5,6].…”

Magnesium sulfate overdose resulting in maternal cardiac arrest: a case report

“…a) CCT scan/nativ, retrospectively a pathologic lesion can be seen (arrow). (b) MRT head FLAIR, a right frontal lesion is identifiable, which was read by the radiologist as cavernoma with hemorrhage or intracerebral hemorrhage explain why albeit the problem of magnesium overdosing has been known for at least 30 years it is still reported frequently [13][14][15][16][17]. Most scientific societies recommend administering 4 to 6 g of magnesium sulfate to women with eclampsia to prevent further eclamptic fits [2,5,[18][19][20].…”

Magnesium in the Acute Care Setting

“…The toxicity is directly correlated with the serum concentration. In order of ascending magnesium concentration, features include loss of deep tendon reflexes ( usually at Mg levels of 3.5-5.0 mmol/l), respiratory paralysis ( at Mg levels 5.0-6.5 mmol/l), cardiac arrhythmias and cardiac arrest (>7.5 mmol/l levels) [33]. The management of magnesium toxicity is with calcium gluconate, which is given to patients presenting with cardiac side effects.…”

“…The management of magnesium toxicity is with calcium gluconate, which is given to patients presenting with cardiac side effects. Furosemide can be given as well to increase the renal excretion of magnesium [33].…”