title: Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports.
abstract: Two premature newborn infants developed extreme magnesium toxicity while receiving total parenteral nutrition (TPN) infusion. Both patients exhibited acute hypotonia, apnea, hypotension, and refractory bradycardia mimicking septic shock syndrome. The complete blood count was normal, and blood cultures were negative. Serum magnesium concentration in 1 patient was 43.1 mEq/L and in the other patient was 45 mEq/L (normal values for serum magnesium being 1.6-2.1 mEq/L). Hypermagnesemia resulted from malfunction of an automated TPN mixing device. Unexplained sudden onset of apnea, refractory bradycardia, and hypotension should raise suspicions of hypermagnesemia, a reversible condition if identified and treated early.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Cardinal Glennon Children's Hospital, St Louis University, St Louis, Missouri 63104, USA. alia3@slu.edu
authors.forename: Ayoob
authors.initials: A
authors.lastname: Ali
authors.forename: Corinne
authors.initials: C
authors.lastname: Walentik
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Mantych
authors.forename: H Farouk
authors.initials: HF
authors.lastname: Sadiq
authors.forename: William J
authors.initials: WJ
authors.lastname: Keenan
authors.forename: Akhihiko
authors.initials: A
authors.lastname: Noguchi
mesh_terms: D001919:Bradycardia / Q000139:chemically induced; D003951:Diagnostic Errors; D004339:Drug Compounding / Q000295:instrumentation; D004868:Equipment Failure; D005078:Exchange Transfusion, Whole Blood; D005526:Food, Formulated / Q000009:adverse effects / Q000032:analysis; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007049:Iatrogenic Disease; D007225:Infant Food / Q000009:adverse effects* / Q000032:analysis; D007231:Infant, Newborn; D007234:Infant, Premature; D008133:Long QT Syndrome / Q000139:chemically induced; D008274:Magnesium / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood / Q000506:poisoning; D008297:Male; D009123:Muscle Hypotonia / Q000139:chemically induced; D010289:Parenteral Nutrition, Total; D012772:Shock, Septic / Q000175:diagnosis*
chemical_list: D008274:Magnesium