Gren J, Woolf A
Division of Pharmacology & Toxicology, Children's Hospital, Boston, Massachusetts.
Ann Emerg Med. 1989 Feb;18(2):200-3. doi: 10.1016/s0196-0644(89)80116-7.
While clinicians have raised concerns about giving multiple doses of a cathartic as a part of therapy for acute poisoning, fears of excessive magnesium absorption or fluid or electrolyte imbalances have been largely unrealized. We present the case of a 19-year-old woman with anorexia nervosa and long-term laxative abuse who, despite a normal baseline serum magnesium concentration, developed hypermagnesemia during treatment with multiple doses of activated charcoal-magnesium citrate for acute salicylate intoxication. The peak serum magnesium concentration, after two doses of magnesium citrate, reached 9.8 mg/dL (4.0 mmol/L). It fell to normal levels when sorbitol was substituted as a cathartic and after the patient had been hemodialyzed for symptoms of salicylate toxicity that continued despite conventional therapy. While disordered magnesium metabolism in one patient with a severe underlying medical condition should not interdict the use of repetitive doses of magnesium citrate as a cathartic, patients requiring such therapy should have serum magnesium concentrations measured serially to monitor for signs of magnesium loading.
虽然临床医生对将多次给予泻药作为急性中毒治疗的一部分表示担忧，但对过量镁吸收或液体或电解质失衡的担忧在很大程度上并未成为现实。我们报告一例19岁神经性厌食症且长期滥用泻药的女性病例，该患者尽管基线血清镁浓度正常，但在多次服用活性炭 - 枸橼酸镁治疗急性水杨酸盐中毒期间发生了高镁血症。服用两剂枸橼酸镁后，血清镁浓度峰值达到9.8mg/dL（4.0mmol/L）。当改用山梨醇作为泻药且患者因尽管接受了常规治疗但仍持续存在的水杨酸盐中毒症状进行血液透析后，血清镁浓度降至正常水平。虽然一名患有严重基础疾病的患者出现镁代谢紊乱不应妨碍重复使用枸橼酸镁作为泻药，但需要这种治疗的患者应定期检测血清镁浓度，以监测镁负荷迹象。
