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Maggie McGee
Magnesium
| Question | Answer |
|---|---|
| Magnesium is the most abundant _______ in _________ fluid second to potassium. | cation – intracellular |
| 60 percent of the body’s magnesium is in what? | the bones |
| Less than 1 percent of the body’s magnesium is where? | extracellular fluid |
| More than 39 percent of the body’s magnesium is where? | intracellular fluid |
| What does magnesium have to do with carbohydrate metabolism? | Magnesium promotes enzyme reactions within the cell during carbohydrate metabolism. |
| What role does magnesium play in energy production? | Magnesium helps the body produce and use ATP. |
| Name 4 things that require magnesium for production. | ATP, DNA, Protein synthesis, Parathyroid hormone |
| How does magnesium help the cardiovascular system function? | Magnesium influences vasodilation as well as irritability and contractility of the cardiac muscles. |
| Why does magnesium have an influence on sodium and potassium balance? | Magnesium helps sodium and potassium ions cross the cell membrane. |
| Why are patients with vascular disease and low magnesium levels at greater risk for strokes? | Magnesium acts at myoneural junctions affecting irritability and contractility of cardiac and skeletal muscle. A stroke is a neuromuscular event. |
| What does parathyroid hormone do? | carries calcium to extracellular fluid (the blood). |
| How is magnesium related to calcium levels? | magnesium is needed to produce PTH which maintains constant calcium levels in the blood. |
| Normal adult magnesium level | 1.8 to 2.5 mEq/L |
| Normal neonate magnesium level | 1.4 to 2.9 mEq/L |
| Normal child magnesium level | 1.6 to 2.6 mEq/L |
| What is the normal magnesium level in cells? | about 40mEq/L |
| Why are serum magnesium levels alone unreliable indicators of magnesium imbalances? | Serum levels may not accurately indicate a patient’s magnesium stores since most magnesium is found inside cells, not in the serum. |
| Why are serum albumin levels used to assess magnesium levels? | Because 30% of serum magnesium binds with albumin (and other proteins) so when a patient’s albumin is low so is their magnesium. |
| In what forms is magnesium found in the blood? | ½ is in a free inonized form, 30% binds to protein- mostly albumin, the remainder binds to other substances. |
| What systems are responsible for the regulation of magnesium? | the GI and urinary systems regulate magnesium through absorption, excretion, and retention. |
| Name seven foods that are good sources of magnesium. | Chocolate, dry beans and peas, leafy greens, meats, nuts, seafood, whole grains |
| How efficient are the kidneys at conserving magnesium? | Pretty darn efficient - The kidneys can restrict loss to just one mEq per day. |
| Hypomagnesemia | levels below 1.8 mEq/L |
| How common is hypomagnesemia? | Although often overlooked, hypomagnesmia affects 10% of all hospitalized patients, especially the critically ill patients. |
| We would not really expect to see signs and symptoms associated with hypomagnesemia until levels fall to what? | below 1 mEq/L |
| Name 4 ways to get to hypomagnesemia. | insufficient dietary magnesium, poor absorption in the GI tract, Pooping too much out, Peeing too much out |
| Name 5 worse case scenario/life threatening results of hypomagnesemia. | Cardiac arrhythmias, Digoxin toxicity, Laryngeal stridor, Respiratory muscle weakness, Seizures |
| What are some general signs and symptoms of hypomagnesemia (hDWCRTVAD)? | hyperactive DTRs, weakness, muscle cramping, rapid heartbeat, tremor, vertigo, ataxia, and depression. |
| Define ataxia | Inability to coordinate voluntary muscle movements, unsteady movements and gait |
| Name three ways that alcoholics pay in magnesium loss. | poor diet, excessive magnesium loss from more frequent urination or vomiting. |
| Give 3 examples of patients who would be at risk for hypomagnesemia because they cannot take magnesium orally. | Pateints receiving prolonged IV fluid, total parenteral nutrition, or enteral feeding formula lacking in magnesium |
| Why are patients with diabetes mellitus at risk for hypomagnesemia? | because of osmotic diuresis leading to excessive magnesium loss. |
| According to one study what could prevent the development of type 2 diabetes? | a magnesium rich diet |
| Name 7 conditions that would diminish the amount of magnesium absorbed in the GI tract (MCBSUCP). | malabsorption syndromes, Crohn’s disease, bowel resection, steatorrhea, ulcerative colitis, cancer, pancreatic insufficiency |
| What ions if excessive in the GI tract prevent the absorption of magnesium? | calcium or phosphorous |
| Why is it that a person with prolonged diarrhea or fistula drainage can have magnesium deficiency? | because fluids in the GI tract (especially the lower GI) contain magnesium |
| What affect does laxative abuse have on mangnesium levels? | same as prolonged diarrhea – decreased magnesium levels |
| What condition causes magnesium to form soap with fatty acids leading to the loss of magnesium from circulation? | acute pancreatitis |
| Name five conditions that could cause a patient to lose too much magnesium in urine leading to hypomagnesemia ( AHHDR). | Primary aldosteronism, Hyperparathyroidism, Hypoparathyroidism, Diabetic Ketoacidosis, Renal disorders (like glomerulonephritis, pyelonephritis, renal tubular acidosis) |
| Name some drugs that could cause a patient to lose too much magnesium in urine (ACCPADL. | amphotericin B, Cisplastin, Cyclosporine, Pentamidine isethionate, Aminoglycoside antibiotics like tobramycin or gentamicin, Diuretics – loop or thiazide, laxatives |
| Patients undergoing hemodialysis, pregnant patients, and patients receiving hypertonic have what risk in common? | dramatic drop in magnesium level |
| What is the effect of body fluid loss on magnesium level? | lowers it |
| How does hypercalcemia affect magnesium level? | lowers it |
| How does hypothermia affect magnesium level? | lowers it |
| How does SIADH affect magnesium level? | lowers it |
| What is SIADH? | ? Syndrome of Inappropriate Antidiuretic Hormone secretion |
| How does sepsis affect magnesium level? | lowers it |
| How do serious burns affect magnesium levels? | lowers them |
| How do wounds requiring debridment affect magnesium levels? | lowers them |
| Any condition that causes urine levels of what cations to be high predisposes a patient to hypmagnesemia? | calcium or sodium |
| What is pentamidine isethionate used for? | prophylaxis and treatment of Pneumocystis Pneumonia |
| What kind of drug is amphotericin B? | Antifungal |
| What is Cisplastin used for? | Cancer – chemotherapy |
| How severe are the signs and symptoms of hypomagnesemia? | The signs and symptoms of hypomagnesemia range from non-existant/mild to life threatening. |
| What 4 body systems are affected by hypomagnesemia? | GI, CNS, Neuromusclular, and Cardiovascular |
| What are all the possible symptoms of hypomagnesemia as it affects the CNS? (AACDDEHIPSV) | Altered LOC, Ataxia, Confusion, Delusions, Depression, Emotional lability, Hallucinations, Insomnia, Psychosis, Seizures, Vertigo |
| What are the 3 Ts and DTR? What system is affected? | Tetany, Twitching, Tremors and Hyperactive Deep Tendon Reflexes – Signs and symptoms of hypomagnesemia related to the neuromuscular system |
| What two signs do we check for hypocalcemia when we suspect our patient has hypomagnesemia? | Chvostek’s sign and Trousseau’s sign |
| What is Chvostek’s sign? | Facial twitching when the facial nerve is tapped. |
| What is Trousseau’s sign? | Carpal spasm when the upper arm is compressed |
| How does the body compensate for low serum magnesium levels? | magnesium moves out of cells |
| What happens to muscle and nerve cells as magnesium moves out? | Muscles become weak and nerves and muscles become hyperirritable. |
| What are the signs and symptoms of hypomagnesemia related to the neuromuscular system? | Muscle weakness, cramps in legs and feet, hyperactive DTRs, Tetany, Chvostek’s and Trouseau’s signs |
| What is tetany? | involuntary muscle spasms |
| What are the signs of hypomagnesemia related to the Cardiovascular system? | Tachycardia, hypertension, ECG |
| What are the signs and symptoms of hypomagnesemia related to the GI system? | dysphagia, anorexia, nausea, vomiting |
| When Grading DTRs 0 means… | Absent |
| DTRs graded + are? | Present but diminished |
| DTRs graded ++ are? | Normal |
| DTRs graded +++ are? | Increased but not necessarily abnormal |
| DTRs graded ++++ are? | Hyperactive Clonic |
| STARVED | Seizures, Tetany, Anorexia or Arrhythmias, Rapid Heart Rate, Vomiting, Emotional lability, Deep Tendon Reflexes increased |
| How would low magnesium level affect digoxin? | Increases retention of Digoxin |
| What are the signs of Digoxin toxicity?(NAAVY) | Nausea Anorexia, Arrhythmias, Vomiting, Yellow tinged vision |
| What do GI symptoms of hypomagnesemia do to complicate treatment? | interfere with magnesium intake and worsen magnesium loss ( anorexia, dysphagia, N&V) |
| What are the characteristics of a ECG when the patient has hypomagnesemia? | prolonged PR and QT interval, Widened QRS complex, Depressed ST segment, Broad Flat T wave, Prominent U wave |
| What is steatorrhea? | too much fat in feces, foul smelling, frothy feces due to a fat metabolism problem or malabsorption problem |
| What are the treatment options for hypomagnesemia (P, D, M,M)? | Prevention, Diet, Magnesium chloride supplement, Magnesium sulfate IM or I.V. |
| Why is magnesium chloride preferred to magnesium oxide as a dietary supplement for hypomagnesemia? | Because magnesium oxide is poorly absorbed and can cause alkalosis |
| Why would a patient need to continue magnesium chloride supplements for several days after serum levels return to normal? | Because it takes a few days to restore magnesium levels inside the cells |
| What must be assessed before administering Magnesium sulfate? | Renal function. |
| What do we do if our patient needs magnesium sulfate and renal function is impaired? | closely monitor magnesium levels |
| Why is that hypermagnesemia is less common than hypokalemia? | Because, typically, the kidneys can reduce the amount of excess magnesium in the body pretty quickly and effectively. |
| What are the two big general reasons that magnesium levels become excessive? | Excessive intake and impaired excretion (Kidney dysfunction) |
| What is the most common cause of hypermagnesemia? | Renal dysfunction |
| Name 5 kidney related conditions that lead to hypermagnesemia ( ARAAuD). | Advanced age (reduced renal function); Renal failure; Addison’s disease; adrenocortical insufficiency; untreated Diabetic Ketoacidosis. |
| What kind of otc drugs can cause hypermagnesemia if the patient has renal failure? | antacids and laxatives with magnesium like Gaviscon, Maalox, and Milk of Magnesia |
| What affect does hypermagnesemia have on the neuromuscular system? | It blocks neuromuscular transmission leading to decreased muscle and nerve activity, weakness, and decreased DTRs. |
| Give 3 situations when a patient may receive a continuous infusion of magnesium. | To treat seizures, pregnancy-induced hypertension, preterm labor |
| We need to guard our patients receiving continuous infusion of magnesium from what dangerous condition? | hypermagnesemia |
| What danger is associated with injecting a bolus dose of magnesium sulfate? | cardiac arrest |
| When administering magnesium sulfate, the infusion must go in slowly. What rate is acceptable? | no faster than 150mg/minute |
| When administering magnesium sulfate we monitor our patient every 15 minutes for signs of hypermagnesemia. What are we looking for? | hypotension and respiratory distress |
| How often does a patient’s serum magnesium levels need to be checked if he is receiving magnesium sulfate? | after each bolus or at least every 6 hours if he has continuous I.V. drip |
| Patients with what condition are at increased risk for hypermegnesemia? | any impairment of renal function |
| Why is it important to monitor a patient’s I&O if they are receiving magnesium? | If the patient does not produce enough urine, they are in danger of magnesium toxicity. |
| We need to notify the doctor when our patient receiving magnesium infusion has an output of what? | <100mL over 4 hours |
| Where do IM magnesium injections go? | Deep gluteal muscle |
| Why alternate injection sites for IM magnesium? | They really hurt. |
| Why would we need to clarify a physician’s order that only specified how many vials or ampules of magnesium sulfate to give? | Because magnesium sulfate comes in 10%, 12.5%, and 50% concentrations |
| Name 11 things that should be documented for a patient with hypomagnesemia. | Vital signs; heart rhythm; neurologic, neuromuscular and cardiac assessments; drugs administered; I&O; seizure/safety precautions; interventions/response; labs-electrolytes, albumin, digoxin; DR notification; Pt teaching |
| What needs to be on hand to counteract adverse reactions to magnesium sulfate infusion? | Calcium gluconate and resuscitation equipment |
| The abbreviation for magnesium sulfate is MgSO4. We write it out long hand to avoid confusion with what other drug? | Morphine sulfate MSO4 |
| What are the signs and symptoms of hypermagnesemia and how do they compare to the signs and symptoms of hypomagnesemia (D, hD, F, W, N)? | Decreased muscle and nerve activity; hypoactive DTR; Facial paresthesia; Generalized weakness (up to flaccid paralysis); occasional N&V - Opposite of hypomagnesemia |
| What signs and symptoms are associated with serum magnesium levels of 3 mEq/L (WFHN)? | Feelings of Warmth; Flushed appearance; Mild Hypotension; N&V |
| What signs and symptoms are associated with serum magnesium levels of 4 mEq/L (FDM)? | Facial paresthesia; Diminished DTRs; Muscle weakness |
| What signs and symptoms are associated with serum magnesium levels of 5 mEq/L (DEBH)? | Drowsiness; Electorcardiogram changes; Bradycardia; Worsening Hypotension |
| What signs and symptoms are associated with serum magnesium levels of 7 mEq/L ? | Loss of DTRs |
| What signs and symptoms are associated with serum magnesium levels of 8 mEq/L ? | Respiratory compromise |
| What signs and symptoms are associated with serum magnesium levels of 12 mEq/L ? | Heart Block, Coma |
| What signs and symptoms are associated with serum magnesium levels of 15 mEq/L ? | Respiratory arrest |
| What signs and symptoms are associated with serum magnesium levels of 20 mEq/L ? | Cardiac Arrest |
| What are the effects of hypermagnesemia on the CNS? | CNS depression makes the patient appear sleepy and lethargic. LOC may disintegrate to COMA |
| Give the progression of hypermagnesemia treatment (FDCMH). | Prevention; Fluids to increase urine output and magnesium excretion; diuretics if renal function is okay; Calcium Gluconate ( magnesium antagonist); mechanical ventilation may be necessary; hemodialysis with magnesium free dialysate |
| Take steps to prevent hypermagnesemia in high risk patients. Who are high risk patients for hypermagnesemia (ERPNSHADDH)? | Elderly; Renal problems; Pregies with hypertension or preterm labor; Neonates when mom gets MgSO4; on MgSO4 for seizures; High intake of laxative/antacid; Adrenal insufficiency; Dehydrated; severe DKA; hypothyroidism |
| What are the effects of hypermagnesemia and hypomagnesemia on neuromuscular excitability? | hypomagnesemia increases neuromuscular excitability hypermagnesemia decreases it. |
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Perseverandovercome
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