Hypermagnesemia NCLEX Review Notes

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February 8, 2016

Hyper: “excessive”

Magnes: prefix for magnesium

Emia: blood

Meaning of Hypermagnesemia: High levels of magnesium in the blood

Normal Levels of Magnesium: 1.6 to 2.6 mg/dL (>2.6 hypermagnesemia)

Magnesium plays a role in: major cell functions like transferring and storing energy,
regulation of parathyroid hormone PTH (which also plays a role in calcium levels). In severe
cases of hypermagnesemia, the release of calcium is inhibited (because the PTH is
suppressed) and that is why you can see hypocalcemia if you have a severely high magnesium
level is present. Magnesium also plays a role in the metabolism of carbs, lipids, and proteins,
and blood pressure regulation.

Magnesium is absorbed in the small intestine and excreted via the kidneys (any issues with
these systems can cause magnesium level issues).

Causes of Hypermagnesemia
Remember “MAG”

Hypermagnesemia is less common than hypomagnesemia. It typically happens when you are
trying to correct hypomagnesemia with magnesium sulfate IV infusion. However, other
causes can include:

Magnesium containing antacids and laxatives***(Mylanta, Maalox)

Addison’s disease (adrenal insufficiency)

Glomerular filtration insufficiency (<30mL/min) renal failure. This is because the kidneys
are keeping too much magnesium.

Signs & Symptoms Hypermagnesemia

Remember: Every system of the body is “Lethargic” (opposite of hypomagnesemia where
the body systems are experiencing hyper-excitability)

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Note: You will typically only see symptoms in severe cases of hypermagnesemia (mild cases
patient will be asymptomatic)

Lethargy (profound)

EKG changes with prolonged PR & QT interval and widened QRS complex

Tendon reflexes absent/grossly diminished

Hypotension

Arrhythmias (bradycardia, heart blocks)

Respiratory arrest

GI issues (nausea, vomiting)

Impaired breathing (due to skeletal weakness)

Cardiac arrest

Nursing Interventions for Hypermagnesemia

Monitor cardiac, respiratory, neuro system, renal status. Put patient on cardiac monitor
(watch for EKG changes)
Ensure safety due to lethargic/drowsiness
Prevention:

1. Avoid giving Magnesium containing antacids/laxative to patients with renal failure

2. Assess for hypermagnesemia during IV infusions of magnesium sulfate for
hypomagnesemia (sign and symptom would be diminished/absent deep tendon
reflexes)
3. Withhold foods high in magnesium, such as:

Remember: “Always Get Plenty Of Foods Containing Large Numbers of Magnesium”

Avocado
Green leafy vegetables
Peanut Butter, potatoes, pork
Oatmeal
Fish (canned white tuna/mackerel)
Cauliflower, chocolate (dark)
Legumes
Nuts
Oranges
Milk

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Administer diuretics that waste magnesium (if patient is not in renal failure) such as
Loop and Thiazide diuretics
Patient in renal failure patient prep for dialysis
IV calcium may be order to reverse side effects of Magnesium (watch IV for
infiltration…prefer central line)

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