title: An Unusual yet "Mg"nificent Indication for Hemodialysis.
abstract: Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary to Renacidin administration, a rarely used agent used for intra-renal pelvic or intra-vesicular instillation dissolution of struvite stones. The patient also had concurrent acute kidney injury (AKI). The patient's magnesium was as high as 16.7 mg/dL, and he initially received hemodialysis followed by continuous venovenous hemodialysis. These therapies resulted in a rapid reduction in magnesium levels and eventual resolution of the muscular weakness. The case discussion highlights several key aspects of magnesium homeostasis, the limited mechanistic understanding of Renacidin-induced hypermagnesemia, and the role of renal replacement therapies in the treatment of hypermagnesemia.
authors.affiliation: Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Amar D
authors.initials: AD
authors.lastname: Bansal
authors.affiliation: Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Dan
authors.initials: D
authors.lastname: Negoianu
authors.affiliation: Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Warburton
mesh_terms: D058186:Acute Kidney Injury; D000328:Adult; D002951:Citrates / Q000009:adverse effects*; D006801:Humans; D008274:Magnesium / Q000097:blood* / Q000633:toxicity*; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced; D010243:Paralysis / Q000139:chemically induced; D006435:Renal Dialysis
chemical_list: D002951:Citrates; C026485:hemiacidrin; D008274:Magnesium