Premkumar C R, Parthasarathy R, Kumar S, Vijaykumar S
Institute of Kidney, Urology and Organ Transplant Madras Medical Mission Chennai India.
Department of Cardiac Anaesthesia and Intensive Care Madras Medical Mission Chennai India.
Anaesth Rep. 2022 Mar 24;10(1):e12154. doi: 10.1002/anr3.12154. eCollection 2022 Jan-Jun.
Hypermagnesaemia is an uncommon electrolyte disorder which can be fatal if not recognised and treated promptly. The signs and symptoms of hypermagnesaemia are non-specific, making it an under-diagnosed cause of cardiovascular dysfunction, hypocalcaemia, and neurological and respiratory depression. Since magnesium homeostasis is handled almost exclusively by the kidneys, symptomatic hypermagnesaemia seldom occurs in the context of normal renal function; when it does, it is usually iatrogenic. Here, we report a case of iatrogenic hypermagnesaemia which presented as respiratory depression, preventing weaning from mechanical ventilation following cardiac surgery in a patient in the early stages of chronic kidney disease. On investigation he was found to have isolated severe hypermagnesaemia, following an intravenous bolus of magnesium sulphate administered intra-operatively to treat tachyarrhythmia. Before administering intravenous magnesium therapeutically, it is important for clinicians to assess renal function and baseline serum magnesium along with other possible risk factors for hypermagnesaemia, and to actively look for signs and symptoms of magnesium toxicity when the patient is receiving therapeutic magnesium.
高镁血症是一种罕见的电解质紊乱，如果不及时识别和治疗可能会致命。高镁血症的体征和症状不具有特异性，这使其成为心血管功能障碍、低钙血症以及神经和呼吸抑制的漏诊原因。由于镁的稳态几乎完全由肾脏调节，在肾功能正常的情况下很少发生有症状的高镁血症；一旦发生，通常是医源性的。在此，我们报告一例医源性高镁血症病例，该病例表现为呼吸抑制，导致一名处于慢性肾脏病早期的患者心脏手术后无法撤机。经检查发现，该患者在术中静脉推注硫酸镁治疗快速性心律失常后出现了单纯性严重高镁血症。在进行静脉镁治疗之前，临床医生评估肾功能、基线血清镁水平以及其他可能导致高镁血症的风险因素，并在患者接受镁治疗时积极寻找镁中毒的体征和症状非常重要。
