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Maggie McGee


Magnesium is the most abundant _______ in _________ fluid second to potassium. cation – intracellular
60 percent of the body’s magnesium is in what? the bones
Less than 1 percent of the body’s magnesium is where? extracellular fluid
More than 39 percent of the body’s magnesium is where? intracellular fluid
What does magnesium have to do with carbohydrate metabolism? Magnesium promotes enzyme reactions within the cell during carbohydrate metabolism.
What role does magnesium play in energy production? Magnesium helps the body produce and use ATP.
Name 4 things that require magnesium for production. ATP, DNA, Protein synthesis, Parathyroid hormone
How does magnesium help the cardiovascular system function? Magnesium influences vasodilation as well as irritability and contractility of the cardiac muscles.
Why does magnesium have an influence on sodium and potassium balance? Magnesium helps sodium and potassium ions cross the cell membrane.
Why are patients with vascular disease and low magnesium levels at greater risk for strokes? Magnesium acts at myoneural junctions affecting irritability and contractility of cardiac and skeletal muscle. A stroke is a neuromuscular event.
What does parathyroid hormone do? carries calcium to extracellular fluid (the blood).
How is magnesium related to calcium levels? magnesium is needed to produce PTH which maintains constant calcium levels in the blood.
Normal adult magnesium level 1.8 to 2.5 mEq/L
Normal neonate magnesium level 1.4 to 2.9 mEq/L
Normal child magnesium level 1.6 to 2.6 mEq/L
What is the normal magnesium level in cells? about 40mEq/L
Why are serum magnesium levels alone unreliable indicators of magnesium imbalances? Serum levels may not accurately indicate a patient’s magnesium stores since most magnesium is found inside cells, not in the serum.
Why are serum albumin levels used to assess magnesium levels? Because 30% of serum magnesium binds with albumin (and other proteins) so when a patient’s albumin is low so is their magnesium.
In what forms is magnesium found in the blood? ½ is in a free inonized form, 30% binds to protein- mostly albumin, the remainder binds to other substances.
What systems are responsible for the regulation of magnesium? the GI and urinary systems regulate magnesium through absorption, excretion, and retention.
Name seven foods that are good sources of magnesium. Chocolate, dry beans and peas, leafy greens, meats, nuts, seafood, whole grains
How efficient are the kidneys at conserving magnesium? Pretty darn efficient - The kidneys can restrict loss to just one mEq per day.
Hypomagnesemia levels below 1.8 mEq/L
How common is hypomagnesemia? Although often overlooked, hypomagnesmia affects 10% of all hospitalized patients, especially the critically ill patients.
We would not really expect to see signs and symptoms associated with hypomagnesemia until levels fall to what? below 1 mEq/L
Name 4 ways to get to hypomagnesemia. insufficient dietary magnesium, poor absorption in the GI tract, Pooping too much out, Peeing too much out
Name 5 worse case scenario/life threatening results of hypomagnesemia. Cardiac arrhythmias, Digoxin toxicity, Laryngeal stridor, Respiratory muscle weakness, Seizures
What are some general signs and symptoms of hypomagnesemia (hDWCRTVAD)? hyperactive DTRs, weakness, muscle cramping, rapid heartbeat, tremor, vertigo, ataxia, and depression.
Define ataxia Inability to coordinate voluntary muscle movements, unsteady movements and gait
Name three ways that alcoholics pay in magnesium loss. poor diet, excessive magnesium loss from more frequent urination or vomiting.
Give 3 examples of patients who would be at risk for hypomagnesemia because they cannot take magnesium orally. Pateints receiving prolonged IV fluid, total parenteral nutrition, or enteral feeding formula lacking in magnesium
Why are patients with diabetes mellitus at risk for hypomagnesemia? because of osmotic diuresis leading to excessive magnesium loss.
According to one study what could prevent the development of type 2 diabetes? a magnesium rich diet
Name 7 conditions that would diminish the amount of magnesium absorbed in the GI tract (MCBSUCP). malabsorption syndromes, Crohn’s disease, bowel resection, steatorrhea, ulcerative colitis, cancer, pancreatic insufficiency
What ions if excessive in the GI tract prevent the absorption of magnesium? calcium or phosphorous
Why is it that a person with prolonged diarrhea or fistula drainage can have magnesium deficiency? because fluids in the GI tract (especially the lower GI) contain magnesium
What affect does laxative abuse have on mangnesium levels? same as prolonged diarrhea – decreased magnesium levels
What condition causes magnesium to form soap with fatty acids leading to the loss of magnesium from circulation? acute pancreatitis
Name five conditions that could cause a patient to lose too much magnesium in urine leading to hypomagnesemia ( AHHDR). Primary aldosteronism, Hyperparathyroidism, Hypoparathyroidism, Diabetic Ketoacidosis, Renal disorders (like glomerulonephritis, pyelonephritis, renal tubular acidosis)
Name some drugs that could cause a patient to lose too much magnesium in urine (ACCPADL. amphotericin B, Cisplastin, Cyclosporine, Pentamidine isethionate, Aminoglycoside antibiotics like tobramycin or gentamicin, Diuretics – loop or thiazide, laxatives
Patients undergoing hemodialysis, pregnant patients, and patients receiving hypertonic have what risk in common? dramatic drop in magnesium level
What is the effect of body fluid loss on magnesium level? lowers it
How does hypercalcemia affect magnesium level? lowers it
How does hypothermia affect magnesium level? lowers it
How does SIADH affect magnesium level? lowers it
What is SIADH? ? Syndrome of Inappropriate Antidiuretic Hormone secretion
How does sepsis affect magnesium level? lowers it
How do serious burns affect magnesium levels? lowers them
How do wounds requiring debridment affect magnesium levels? lowers them
Any condition that causes urine levels of what cations to be high predisposes a patient to hypmagnesemia? calcium or sodium
What is pentamidine isethionate used for? prophylaxis and treatment of Pneumocystis Pneumonia
What kind of drug is amphotericin B? Antifungal
What is Cisplastin used for? Cancer – chemotherapy
How severe are the signs and symptoms of hypomagnesemia? The signs and symptoms of hypomagnesemia range from non-existant/mild to life threatening.
What 4 body systems are affected by hypomagnesemia? GI, CNS, Neuromusclular, and Cardiovascular
What are all the possible symptoms of hypomagnesemia as it affects the CNS? (AACDDEHIPSV) Altered LOC, Ataxia, Confusion, Delusions, Depression, Emotional lability, Hallucinations, Insomnia, Psychosis, Seizures, Vertigo
What are the 3 Ts and DTR? What system is affected? Tetany, Twitching, Tremors and Hyperactive Deep Tendon Reflexes – Signs and symptoms of hypomagnesemia related to the neuromuscular system
What two signs do we check for hypocalcemia when we suspect our patient has hypomagnesemia? Chvostek’s sign and Trousseau’s sign
What is Chvostek’s sign? Facial twitching when the facial nerve is tapped.
What is Trousseau’s sign? Carpal spasm when the upper arm is compressed
How does the body compensate for low serum magnesium levels? magnesium moves out of cells
What happens to muscle and nerve cells as magnesium moves out? Muscles become weak and nerves and muscles become hyperirritable.
What are the signs and symptoms of hypomagnesemia related to the neuromuscular system? Muscle weakness, cramps in legs and feet, hyperactive DTRs, Tetany, Chvostek’s and Trouseau’s signs
What is tetany? involuntary muscle spasms
What are the signs of hypomagnesemia related to the Cardiovascular system? Tachycardia, hypertension, ECG
What are the signs and symptoms of hypomagnesemia related to the GI system? dysphagia, anorexia, nausea, vomiting
When Grading DTRs 0 means… Absent
DTRs graded + are? Present but diminished
DTRs graded ++ are? Normal
DTRs graded +++ are? Increased but not necessarily abnormal
DTRs graded ++++ are? Hyperactive Clonic
STARVED Seizures, Tetany, Anorexia or Arrhythmias, Rapid Heart Rate, Vomiting, Emotional lability, Deep Tendon Reflexes increased
How would low magnesium level affect digoxin? Increases retention of Digoxin
What are the signs of Digoxin toxicity?(NAAVY) Nausea Anorexia, Arrhythmias, Vomiting, Yellow tinged vision
What do GI symptoms of hypomagnesemia do to complicate treatment? interfere with magnesium intake and worsen magnesium loss ( anorexia, dysphagia, N&V)
What are the characteristics of a ECG when the patient has hypomagnesemia? prolonged PR and QT interval, Widened QRS complex, Depressed ST segment, Broad Flat T wave, Prominent U wave
What is steatorrhea? too much fat in feces, foul smelling, frothy feces due to a fat metabolism problem or malabsorption problem
What are the treatment options for hypomagnesemia (P, D, M,M)? Prevention, Diet, Magnesium chloride supplement, Magnesium sulfate IM or I.V.
Why is magnesium chloride preferred to magnesium oxide as a dietary supplement for hypomagnesemia? Because magnesium oxide is poorly absorbed and can cause alkalosis
Why would a patient need to continue magnesium chloride supplements for several days after serum levels return to normal? Because it takes a few days to restore magnesium levels inside the cells
What must be assessed before administering Magnesium sulfate? Renal function.
What do we do if our patient needs magnesium sulfate and renal function is impaired? closely monitor magnesium levels
Why is that hypermagnesemia is less common than hypokalemia? Because, typically, the kidneys can reduce the amount of excess magnesium in the body pretty quickly and effectively.
What are the two big general reasons that magnesium levels become excessive? Excessive intake and impaired excretion (Kidney dysfunction)
What is the most common cause of hypermagnesemia? Renal dysfunction
Name 5 kidney related conditions that lead to hypermagnesemia ( ARAAuD). Advanced age (reduced renal function); Renal failure; Addison’s disease; adrenocortical insufficiency; untreated Diabetic Ketoacidosis.
What kind of otc drugs can cause hypermagnesemia if the patient has renal failure? antacids and laxatives with magnesium like Gaviscon, Maalox, and Milk of Magnesia
What affect does hypermagnesemia have on the neuromuscular system? It blocks neuromuscular transmission leading to decreased muscle and nerve activity, weakness, and decreased DTRs.
Give 3 situations when a patient may receive a continuous infusion of magnesium. To treat seizures, pregnancy-induced hypertension, preterm labor
We need to guard our patients receiving continuous infusion of magnesium from what dangerous condition? hypermagnesemia
What danger is associated with injecting a bolus dose of magnesium sulfate? cardiac arrest
When administering magnesium sulfate, the infusion must go in slowly. What rate is acceptable? no faster than 150mg/minute
When administering magnesium sulfate we monitor our patient every 15 minutes for signs of hypermagnesemia. What are we looking for? hypotension and respiratory distress
How often does a patient’s serum magnesium levels need to be checked if he is receiving magnesium sulfate? after each bolus or at least every 6 hours if he has continuous I.V. drip
Patients with what condition are at increased risk for hypermegnesemia? any impairment of renal function
Why is it important to monitor a patient’s I&O if they are receiving magnesium? If the patient does not produce enough urine, they are in danger of magnesium toxicity.
We need to notify the doctor when our patient receiving magnesium infusion has an output of what? <100mL over 4 hours
Where do IM magnesium injections go? Deep gluteal muscle
Why alternate injection sites for IM magnesium? They really hurt.
Why would we need to clarify a physician’s order that only specified how many vials or ampules of magnesium sulfate to give? Because magnesium sulfate comes in 10%, 12.5%, and 50% concentrations
Name 11 things that should be documented for a patient with hypomagnesemia. Vital signs; heart rhythm; neurologic, neuromuscular and cardiac assessments; drugs administered; I&O; seizure/safety precautions; interventions/response; labs-electrolytes, albumin, digoxin; DR notification; Pt teaching
What needs to be on hand to counteract adverse reactions to magnesium sulfate infusion? Calcium gluconate and resuscitation equipment
The abbreviation for magnesium sulfate is MgSO4. We write it out long hand to avoid confusion with what other drug? Morphine sulfate MSO4
What are the signs and symptoms of hypermagnesemia and how do they compare to the signs and symptoms of hypomagnesemia (D, hD, F, W, N)? Decreased muscle and nerve activity; hypoactive DTR; Facial paresthesia; Generalized weakness (up to flaccid paralysis); occasional N&V - Opposite of hypomagnesemia
What signs and symptoms are associated with serum magnesium levels of 3 mEq/L (WFHN)? Feelings of Warmth; Flushed appearance; Mild Hypotension; N&V
What signs and symptoms are associated with serum magnesium levels of 4 mEq/L (FDM)? Facial paresthesia; Diminished DTRs; Muscle weakness
What signs and symptoms are associated with serum magnesium levels of 5 mEq/L (DEBH)? Drowsiness; Electorcardiogram changes; Bradycardia; Worsening Hypotension
What signs and symptoms are associated with serum magnesium levels of 7 mEq/L ? Loss of DTRs
What signs and symptoms are associated with serum magnesium levels of 8 mEq/L ? Respiratory compromise
What signs and symptoms are associated with serum magnesium levels of 12 mEq/L ? Heart Block, Coma
What signs and symptoms are associated with serum magnesium levels of 15 mEq/L ? Respiratory arrest
What signs and symptoms are associated with serum magnesium levels of 20 mEq/L ? Cardiac Arrest
What are the effects of hypermagnesemia on the CNS? CNS depression makes the patient appear sleepy and lethargic. LOC may disintegrate to COMA
Give the progression of hypermagnesemia treatment (FDCMH). Prevention; Fluids to increase urine output and magnesium excretion; diuretics if renal function is okay; Calcium Gluconate ( magnesium antagonist); mechanical ventilation may be necessary; hemodialysis with magnesium free dialysate
Take steps to prevent hypermagnesemia in high risk patients. Who are high risk patients for hypermagnesemia (ERPNSHADDH)? Elderly; Renal problems; Pregies with hypertension or preterm labor; Neonates when mom gets MgSO4; on MgSO4 for seizures; High intake of laxative/antacid; Adrenal insufficiency; Dehydrated; severe DKA; hypothyroidism
What are the effects of hypermagnesemia and hypomagnesemia on neuromuscular excitability? hypomagnesemia increases neuromuscular excitability hypermagnesemia decreases it.