Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis

  • Jhang, Won Kyoung (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Lee, Yoon Jung (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Kim, Young A (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Park, Seong Jong (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Park, Young Seo (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine)
  • Received : 2012.12.03
  • Accepted : 2012.07.12
  • Published : 2013.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

In this report, we present a pediatric case of severe symptomatic hypermagnesemia resulting from the use of magnesium oxide as a laxative in a child undergoing continuous cyclic peritoneal dialysis for end-stage renal disease. The patient showed abnormal electrocardiography (ECG) findings, such as tall T waves, a widened QRS complex, and irregular conduction, which were initially misdiagnosed as hyperkalemia; later, the correct diagnosis of hypermagnesemia was obtained. Emergent hemodialysis successfully returned the serum magnesium concentration to normal without complications. When abnormal ECG changes are detected in patients with renal failure, hypermagnesemia should be considered.

Keywords

References

  1. Birrer RB, Shallash AJ, Totten V. Hypermagnesemia-induced fatality following epsom salt gargles(1). J Emerg Med 2002;22:185-8. https://doi.org/10.1016/S0736-4679(01)00462-0
  2. Harker HE, Majcher TA. Hypermagnesemia in a pediatric patient. Anesth Analg 2000;91:1160-2.
  3. Onishi S, Yoshino S. Cathartic-induced fatal hypermagnesemia in the elderly. Intern Med 2006;45:207-10. https://doi.org/10.2169/internalmedicine.45.1482
  4. Kontani M, Hara A, Ohta S, Ikeda T. Hypermagnesemia induced by massive cathartic ingestion in an elderly woman without preexisting renal dysfunction. Intern Med 2005;44:448-52. https://doi.org/10.2169/internalmedicine.44.448
  5. Vissers RJ, Purssell R. Iatrogenic magnesium overdose: two case reports. J Emerg Med 1996;14:187-91. https://doi.org/10.1016/0736-4679(95)02115-9
  6. Musso CG. Magnesium metabolism in health and disease. Int Urol Nephrol 2009;41:357-62. https://doi.org/10.1007/s11255-009-9548-7
  7. Ali A, Walentik C, Mantych GJ, Sadiq HF, Keenan WJ, Noguchi A. Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports. Pediatrics 2003;112(1 Pt 1):e70-2. https://doi.org/10.1542/peds.112.1.e70
  8. Topf JM, Murray PT. Hypomagnesemia and hypermagnesemia. Rev Endocr Metab Disord 2003;4:195-206. https://doi.org/10.1023/A:1022950321817
  9. McGuire JK, Kulkarni MS, Baden HP. Fatal hypermagnesemia in a child treated with megavitamin/megamineral therapy. Pediatrics 2000;105:E18. https://doi.org/10.1542/peds.105.2.e18
  10. Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev 2003;24:47-66.
  11. Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003;349:1360-8. https://doi.org/10.1056/NEJMra020995
  12. Singh S, Rao SS. Pharmacologic management of chronic constipation. Gastroenterol Clin North Am 2010;39:509-27. https://doi.org/10.1016/j.gtc.2010.08.001
  13. Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9. https://doi.org/10.1007/BF02234645
  14. Frazao JM, Cobum JW. Safety of magnesium laxatives in dialysis patients. Semin Dial 2007;10:292. https://doi.org/10.1111/j.1525-139X.1997.tb00517.x

Cited by

  1. Magnesium oxide : Severe hypermagnesaemia in a child: case report vol.1465, pp.1, 2013, https://doi.org/10.1007/s40278-013-5214-z
  2. Severe Symptomatic Hypermagnesemia Associated with Over-the-Counter Laxatives in a Patient with Renal Failure and Sigmoid Volvulus vol.2014, pp.None, 2013, https://doi.org/10.1155/2014/560746
  3. Serum Magnesium Levels in Pediatric Inpatients: A Study in Laboratory Overuse vol.5, pp.1, 2013, https://doi.org/10.1542/hpeds.2014-0015
  4. A case report of bittern intoxication vol.8, pp.2, 2015, https://doi.org/10.4103/0974-2700.145426
  5. Fatal Hypermagnesemia: an acute ingestion of Epsom Salt in a patient with normal renal function vol.9, pp.4, 2013, https://doi.org/10.22088/cjim.9.4.413
  6. ECG of the Month vol.256, pp.1, 2013, https://doi.org/10.2460/javma.256.1.56
  7. High-magnesium exposure to bullfrog heart causes ST segment elevation vol.83, pp.4, 2013, https://doi.org/10.1292/jvms.20-0720