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Terms in this set (19)
Excessive serum levels of the magnesium cation
Magnesium enhances neuromuscular integration and stimulates parathyroid hormone secretion, thus regulating intracellular fluid calcium levels.
Magnesium may also regulate skeletal muscles through its influence on calcium utilization by depressing acetylcholine release at synaptic junctions.
Magnesium activates many enzymes for proper carbohydrate and protein metabolism, aids in cell metabolism and the transport of sodium and potassium across cell membranes, and influences sodium, potassium, calcium, and protein levels.
About one-third of magnesium taken into the body is absorbed through the small intestine and is eventually excreted in the urine; remaining unabsorbed magnesium is excreted in the stool.
Hypermagnesemia occurs when renal function deteriorates and the kidneys are unable to filter magnesium effectively, or when the load of magnesium is such that it exceeds the renal excretory capacity.
Chronic renal insufficiency
Overcorrection of hypomagnesemia
Overuse of magnesium-containing antacids
Severe dehydration (resulting oliguria can cause magnesium retention)
Untreated diabetic ketoacidosis
Use of laxatives (magnesium sulfate, milk of magnesia, and magnesium citrate solutions), especially with renal insufficiency (see Drugs and supplements causing hypermagnesemia)
Intestinal hypomotility due to narcotics and anticholinergics or bowel obstruction and chronic constipation
Tumor lysis syndrome
Patients receiving magnesium sulfate to control seizures
This disorder rarely occurs in the United States.
Hypotension (see Clinical effects of hypermagnesemia)
Hyporeflexia (see Testing the patellar reflex)
Diagnostic Test Results-Laboratory
Serum magnesium level is greater than 2.5 mEq/L.
Serum potassium and calcium levels may be elevated.
Creatinine clearance is less than 30 mL/minute.
Arterial blood gas analysis may reveal respiratory acidosis.
Diagnostic Test Results-Diagnostic Procedures
Electrocardiography may show a prolonged PR interval, widened QRS complex, increase in Q-T interval, and tall T waves.
Identification and correction of the underlying cause
Cessation of contributory drug
Peritoneal dialysis or hemodialysis
Increased fluid intake
I.V. fluids, such as normal saline or lactated Ringer's solution
Loop diuretics such as furosemide
Calcium gluconate (10%)
Nursing Considerations-Nursing Diagnoses
Decreased cardiac output
Impaired gas exchange
Risk for ineffective renal perfusion
Risk for injury
Nursing Considerations-Expected Outcomes
identify strategies to reduce anxiety
maintain adequate cardiac output and hemodynamic stability
maintain adequate ventilation and oxygenation
exhibit signs of adequate renal perfusion
remain free from injury and complications.
Nursing Considerations-Nursing Interventions
Institute continuous cardiac monitoring as indicated and report any changes.
Provide sufficient fluids for adequate hydration and maintenance of renal function. Administer I.V. fluid therapy as ordered to treat hypotension and maintain renal function; ensure patent I.V. access if I.V. fluids are ordered.
Expect to stop I.V. fluids when the patient's hemodynamic status is stabilized or pulmonary edema develops.
Give prescribed drugs; administer furosemide I.V. as a single dose.
Use calcium gluconate solution for patients with severe or symptomatic hypermagnesemia.
Obtain specimens for laboratory testing of serum electrolyte levels. Keep in mind that hypermagnesemia rarely occurs in isolation; also evaluate serum potassium and calcium levels, and report abnormal serum electrolyte levels immediately.
Watch patients receiving a cardiac glycoside and calcium gluconate simultaneously because calcium excess enhances the cardiac glycoside.
Prepare the patient for dialysis as indicated if the patient has renal failure and severe elevation of magnesium levels.
Magnesium and other levels
Intake and output
Cardiopulmonary status, including cardiac rate and rhythm
Neuromuscular system, including deep tendon reflexes
Nursing Considerations-Associated Nursing Procedures
12- or 24-hour timed urine collection
Blood pressure assessment
IV bag preparation
IV bolus injection
IV catheter insertion
IV pump use
Intake and output assessment
Oral drug administration
Urine specimen collection, random
disorder, diagnosis, possible cause, and expected treatment
importance of avoiding medications that contain magnesium, such as laxatives and antacids, particularly for elderly patients and those with compromised renal function
signs and symptoms of hypermagnesemia and hypomagnesemia and the need to notify a practitioner if any occur
importance of adhering to follow-up and laboratory testing to evaluate the effectiveness of treatment.
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