White River Health System, Batesville, AR, USA.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620984898. doi: 10.1177/2324709620984898.
Electrolyte abnormalities are an underrecognized cause of respiratory failure in the intensive care unit. One such abnormality is a relatively rare phenomenon of hypermagnesemia resulting in paralysis. A 73-year-old Caucasian male patient presented to the emergency department with diffuse abdominal pain of 2-day duration. He received magnesium citrate and gastrointestinal cocktail for his constipation after initial imaging showed constipation. In view of acute worsening, follow-up computed tomography of the abdomen was done, which showed free air in upper abdomen along with free fluid. Hence, he was taken for emergent laparotomy with repair of pyloric ulcer perforation with omental patch. Post procedure course was complicated by sepsis, acute kidney injury, and respiratory failure with hypoxemia and hypercapnia. On physical examination the patient had flaccid paralysis in all his extremities along with absent brain stem reflexes. Extensive workup including imaging of brain failed to reveal diagnosis. On postoperative day 1, the patient was noted to have magnesium level of 9.2 mg/dL (1.6-2.3 mg/dL), which was thought to be cause of flaccid paralysis and respiratory failure. In view of his acute oliguric kidney injury, he was initiated on intermittent hemodialysis, until his magnesium levels were back to its physiologic limits. His paralysis gradually improved over next 48 to 72 hours and he was liberated from ventilator successfully.
电解质异常是重症监护病房呼吸衰竭的一个未被充分认识的原因。其中一种异常是一种相对罕见的高镁血症现象，导致瘫痪。一名 73 岁的白人男性患者因弥漫性腹痛 2 天就诊于急诊科。他在最初的影像学检查显示为便秘后，接受了镁柠檬酸和胃肠鸡尾酒治疗。鉴于病情急剧恶化，对腹部进行了后续的计算机断层扫描，结果显示上腹部有游离气体和游离液体。因此，他被紧急送往手术室，接受了幽门溃疡穿孔修补术，并用大网膜补丁进行修复。术后病程复杂，并发脓毒症、急性肾损伤和呼吸衰竭，伴有低氧血症和高碳酸血症。体格检查发现患者四肢瘫痪，且无脑干反射。广泛的检查包括脑部影像学检查都未能明确诊断。术后第 1 天，患者的镁水平为 9.2mg/dL（1.6-2.3mg/dL），这被认为是导致瘫痪和呼吸衰竭的原因。鉴于他急性少尿性肾损伤，他开始接受间歇性血液透析，直到他的镁水平恢复到生理极限。他的瘫痪在接下来的 48 到 72 小时内逐渐改善，并成功脱离呼吸机。
