Acute Respiratory Failure Induced by Magnesium Replacement in a 62-Year-Old Woman with Myasthenia Gravis.
Magnesium is known to act at the neuromuscular junction by inhibiting the presynaptic release of acetylcholine and desensitizing the postsynaptic membrane. Because of these effects, magnesium has been postulated to potentiate neuromuscular weakness. We describe the case of a 62-year-old woman with myasthenia gravis and a metastatic thymoma who was admitted to our intensive care unit for management of a myasthenic crisis. The patient's neuromuscular weakness worsened in association with standard intravenous magnesium replacement, and the exacerbated respiratory failure necessitated intubation, mechanical ventilation, and an extended stay in the intensive care unit. The effect of magnesium replacement on myasthenia gravis patients has not been well documented, and we present this case to increase awareness and stimulate research. In addition, we discuss the relevant medical literature.
Paramveer
P
Singh
Olakunle
O
Idowu
Imrana
I
Malik
Joseph L
JL
Nates
D000208:Acute Disease; D061605:Administration, Intravenous; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
D008278:Magnesium Sulfate
Magnesium/blood; magnesium sulfate/administration & dosage/adverse effects/therapeutic use; myasthenia gravis/complications/physiopathology; neuromuscular junction/drug effects; pre-eclampsia/complications; respiratory insufficiency/drug effects; risk factors; vital capacity