Υπερβολική ποσότητα μαγνησίου

　　Acute or chronic renal failure is common, but generally, patients with renal failure have high magnesium levels that can still maintain normal or slightly high levels, and there are no symptoms caused by hypermagnesemia. If there is excessive intake at one time (such as the use of antacids) or excessive entry through other routes (such as intramuscular magnesium sulfate), it may lead to significant hypermagnesemia and symptoms. In addition, thyroid hormone can inhibit reabsorption of magnesium by renal tubules and promote urinary magnesium excretion, so some patients with myxedema can develop hypermagnesemia. Aldosterone also has the effect of inhibiting reabsorption of magnesium by renal tubules and promoting urinary magnesium excretion, so Addison's disease patients may have hypermagnesemia.

　　Common complications of this disease include:

　　1Disappearance of tendon reflexes.

　　2Impairment of cardiac conduction function.

　　3Respiratory depression.

　　4Cardiac arrest.

　　Hypermagnesemia can inhibit myocardial contractility, leading to heart failure or cardiogenic shock. High concentrations of magnesium can inhibit atrioventricular and intraventricular conduction and reduce myocardial excitability, causing conduction block and bradycardia. The ECG may show P-The PR interval is prolonged and the QRS complex is widened.

　　5Magnesium also has inhibitory effects on smooth muscle. During hypermagnesemia, the inhibition of vascular smooth muscle can cause dilation of small arteries and arterioles, leading to decreased peripheral resistance and decreased arterial blood pressure. The inhibition of visceral smooth muscle can cause symptoms such as belching, vomiting, constipation, and urinary retention.

　　The serum magnesium concentration2mmol/Only when L is present will symptoms and signs of magnesium overload appear, mainly including fatigue, weakness, disappearance of tendon reflexes, and blood pressure drop. When the serum magnesium level further increases, cardiac conduction function is impaired, and the ECG shows prolonged PR interval, widened QRS complex, and elevated T wave, similar to the ECG changes of hyperkalemia. In the late stage, respiratory depression, drowsiness, and coma may occur, and even cardiac arrest.

　　When using magnesium-containing drugs, the serum magnesium concentration should be checked regularly to avoid hypermagnesemia.

　　1Prognosis

　　If hypermagnesemia is not diagnosed and treated in time, it can lead to acute or chronic renal insufficiency. It is necessary to monitor blood and urinary magnesium concentrations.

　　2Prevention

　　After the diagnosis of hypermagnesemia is established, efforts should be made to find the cause. If it is caused by iatrogenic factors, the application of magnesium-containing drugs or preparations should be immediately stopped.

　　Firstly, laboratory examination

　　1Secondly, the serum magnesium concentration increases (serum magnesium)1.25mmol/L can directly diagnose hypermagnesemia.

　　224The excretion of urinary magnesium has a great help in the diagnosis of the cause. If the loss decreases, it indicates renal, endocrine, or metabolic factors, otherwise it is due to increased intake or abnormal distribution.

　　Secondly, other auxiliary examinations

　　1Electrocardiogram (ECG) shows conduction block and bradycardia. The ECG manifestations of hypermagnesemia are P-The PR interval is prolonged, QRS is widened, and Q-The T interval is prolonged. Due to the common occurrence of hyperkalemia with hypermagnesemia, a tall and sharp T wave may appear.

　　2Ultrasound examination to detect renal organ changes early.

　　What foods are good for hypermagnesemia patients to eat:

　　Eat more iron-rich foods, such as deep-sea fish, kelp, etc., followed by meat and eggs. Animal organs, such as liver, can also be eaten to supplement iron, but the liver of the organism is prone to accumulate toxins and is not suitable for long-term consumption (it's okay occasionally). Excessive magnesium can drink old tea or fluorinated tap water to make fluorine antagonize magnesium.

　　Calcium and magnesium have a significant antagonistic effect, which can be administered intravenously first10％Gluconate calcium10～20ml or10％Calcium chloride5～10ml, to counteract the inhibition of magnesium on the heart and muscles, while actively correcting acidosis and dehydration. If the serum magnesium does not decrease or the symptoms do not improve, peritoneal dialysis or hemodialysis should be adopted as soon as possible.

　　First, symptomatic treatment

　　1Use calcium ions:Since calcium has an antagonistic effect on magnesium, intravenous injection10％Gluconate calcium or10％Calcium chloride often relieves symptoms, the usual dose is the former10～20ml, the latter5～10ml, injected slowly.

　　2General symptomatic treatment:Respiratory support therapy, antihypertensive therapy, antiarrhythmic therapy, etc. can be used as needed.

　　3Cholinesterase inhibitors:Hypermagnesemia can reduce the release of acetylcholine at the nerve endings, and the use of cholinesterase inhibitors can reduce the destruction of acetylcholine, thereby alleviating the nervous system caused by hypermagnesemia-The decrease in muscle junction excitability. Drugs that can be tried include neostigmine, etc.

　　Secondly, reduce blood magnesium concentration

　　1Increase the excretion of urinary magnesium:Patients with normal renal function can appropriately supplement normal saline or glucose solution to correct dehydration, increase glomerular filtration rate, and accelerate the excretion of magnesium. On the basis of fluid resuscitation, the use of diuretics can increase the excretion of urinary magnesium. Thiazide diuretics and loop diuretics can be used together. However, for patients with obvious renal insufficiency, the use of diuretics is often ineffective.

　　2Blood dialysis:Hypermagnesemia occurring in renal insufficiency is an indication for dialysis therapy because hypermagnesemia often coexists with hypercalcemia in renal insufficiency, and calcium treatment is not appropriate at this time. But note that magnesium-free fluid should be used during dialysis.

　　3Strictly control the intake of magnesium:All magnesium-containing drugs must be discontinued.