Near death by milk of magnesia.
We report a case of hypermagnesemia associated with the use of milk of magnesia in a male patient with end-stage renal disease. After experiencing nausea and vomiting, he developed severe bradycardia and then asystole. Resuscitation efforts were successful; however, he developed atrial fibrillation with severe widening of the QRS and diffuse ST elevation, hypothermia, hypotension and apnoea requiring intubation. Initial diagnoses included ST-elevation myocardial infarction, cardiogenic and/or septic shock and hyperkalaemia. However, serum magnesium was later found to be >4.1 mmol/L (equivalent to >10 mg/dL). He underwent haemodialysis (HD) to remove serum magnesium with remarkable overall improvement. Severe hypermagnesemia can manifest with severe bradycardia and asystole, shock, hypothermia and respiratory failure and can mimic acute coronary syndromes complicated with cardiogenic shock or septic shock. Therefore, clinicians should be aware of this life-threatening condition in patients with significant renal dysfunction. Timely treatment with HD is highly effective and lifesaving.
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Ahmed
http://orcid.org/0000-0003-4908-5386
A
Alaini
Department of Cardiology, Univ New Mexico, Albuquerque, New Mexico, USA.|Department of Cardiology, Veterans Health Administration, Albuquerque, New Mexico, USA.
Carlos A
CA
Roldan
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.|Department of Nephrology, Veterans Health Administration, Albuquerque, New Mexico, USA.
Karen
K
Servilla
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.|Department of Internal Medicine, Veterans Health Administration, Albuquerque, New Mexico, USA.
Elizabeth Sage
ES
Colombo
D000368:Aged; D003956:Dialysis / Q000379:methods; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications; D008274:Magnesium / Q000097:blood*; D008277:Magnesium Oxide / Q000008:administration & dosage / Q000633:toxicity*; D008297:Male; D012151:Resuscitation
D008277:Magnesium Oxide; D008274:Magnesium