Unusual Reason for Urgent Hemodialysis; Iatrogenic Hypermagnesemia

Document Type

Conference Proceeding

Publication Date

5-17-2022

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Hypermagnesemia is a rare disorder, and almost always resulted from iatrogenic cause. In our case report, we present a case of Hypermagnesemia that was severe enough to require urgent dialysis in the ICU. Case Summary: 57 y.o. Female with past medical history significant for asthma/COPD was admitted to the MICU for acute hypoxic & hypercapnic respiratory failure due to status asthmaticus. She presented to the emergency room in acute respiratory distress requiring BIPAP and eventually intubation due to altered mentation secondary to hypercapnia & work of breathing. In the emergency room, she was started on several treatments for status asthmaticus including methylprednisolone, continuous nebulized albuterol, heliox, intramuscular terbutaline, epinephrine & ketamine infusion, and a magnesium infusion. On the ventilator her airway pressures were elevated and she had an elevated auto-peep and therefore she was paralyzed to strictly control her breathing. She was then transferred to the ICU for ongoing management. Her labs showed upon arrival to intensive care unit: Sodium 136 mmol/l, Potassium 4.4 mmol/l, Cr 2.33 (Normal baseline), Mg 4.4 mg/dl. Her repeated labs showed Mg of 12.0 mg/dl, potassium 4.3, sodium 132, lactate 8.6, patient became anuric, given Lasix with no urine output and EKG obtained as shown in the figure. Emergent dialysis done to treat hypermagnesemia after which magnesium level dropped to normal level. EKG showed normalized T waves. Discussion: In our case the magnesium infusion started after a 2-gm bolus. due to severe anuric acute kidney injury diuretics didn't help with hypermagnesemia, thus emergent dialysis needed. EKG showed hyperacute T waves and flattened P waves. Calcium Gluconate given immediately and followed by Dialysis. Conclusion: Hypermagnesemia manifested by: weakness, hypoventilation, hypotension, respiratory muscles paralysis, cardiac arrhythmias. On EKG it shows same features as Hyperkalemia. Hypermagnesemia can be fatal, high index of suspicion required, especially, with EKG changes consistent with hyperkalemia but with a normal serum potassium. Urgent treatment in anuric patient with acute kidney injury can be achieved by dialysis as a treatment of choice. Calcium gluconate can be used if there is EKG changes till the definitive treatment start.

Volume

205

Issue

1

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