Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
J Emerg Med. 2020 May;58(5):767-770. doi: 10.1016/j.jemermed.2020.04.023. Epub 2020 May 7.
Hypermagnesemia is an often overlooked electrolyte abnormality that has a myriad of presenting symptoms. It has been observed after both accidental and intentional ingestions of magnesium-containing compounds, and as in the case presented, Epsom salts, which are primarily magnesium sulfate.
A 56-year-old man presented to the emergency department reporting weakness after an ingestion of Epsom salts used as a laxative and was found to be bradycardic and hypotensive. He subsequently developed altered mental status and respiratory depression necessitating intubation. His magnesium level was found to be > 3.91 mmol/L (> 9.5 mg/dL). He was given multiple doses of calcium gluconate and generous i.v. fluids with furosemide, with minimal improvement. However, his magnesium level corrected rapidly after initiation of dialysis, and 3 days later he was discharged home in good condition with normal neurologic function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Keeping a high level of suspicion for, and quickly recognizing, hypermagnesemia allows for prompt initiation of treatment, which can avoid significant hemodynamic or respiratory compromise. Mainstays of treatment are i.v. calcium and i.v. fluids. Loop diuretics may be given as an adjunct as well. Dialysis should be considered in cases of severe hypermagnesemia because it results in rapid correction of magnesium levels.
高镁血症是一种常被忽视的电解质异常，其临床表现多样。它既可见于镁化合物的意外或故意摄入后，也可见于病例中提到的泻盐，即主要成分为硫酸镁。
一名 56 岁男性因服用泻盐（用作泻药）后出现乏力而到急诊科就诊，被发现心动过缓和低血压。随后他出现精神状态改变和呼吸抑制，需要插管。他的镁水平>3.91mmol/L（>9.5mg/dL）。他接受了多次葡萄糖酸钙和大量静脉补液加呋塞米治疗，但改善甚微。然而，在开始透析后，他的镁水平迅速纠正，3 天后他出院时情况良好，神经功能正常。
为什么急诊医生应该了解这个问题？：保持对高镁血症的高度警惕，并迅速识别，可及时开始治疗，避免严重的血流动力学或呼吸功能障碍。治疗的主要方法是静脉注射钙和静脉补液。也可以给予袢利尿剂作为辅助治疗。对于严重高镁血症，应考虑透析，因为它可迅速纠正镁水平。
