title: Deliberate overdose with Epsom salts.
abstract: Epsom salts contains the active compound magnesium sulfate and is used most commonly as a laxative. There are potential serious toxic effects, including cardiac arrest, when the serum concentration rises above therapeutic values. We present a case of deliberate self poisoning with a large quantity of Epsom salts, resulting in a toxic serum magnesium concentration of 9.7 mmol/l (0.70-1.0 mmol/l). Clinical features included limb weakness, vomiting and confusion, with a subsequent rapid deterioration in level of consciousness and bradydysrhythmia. There was no significant response to calcium gluconate, so haemodialysis was urgently arranged. The patient made a full recovery. Hypermagnesaemia is unusual in patients with normal renal function. Although clinical severity does not always correlate with serum magnesium values, risk of cardiac arrest occurs with concentrations >6 mmol/l. Initial treatment is supportive. Dialysis should be considered when life threatening features or renal impairment are present.
authors.affiliation: Southern General, Emergency Department, Govan Road, Glasgow G51 4TF, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Milne
authors.forename: Pamela
authors.initials: P
authors.lastname: Dean
authors.forename: Martin
authors.initials: M
authors.lastname: Hughes