Neurological manifestations of hypermagnesemia: a narrative review.
Dysautonomia
Hypermagnesemia
Magnesium
Neurological complications
Neuromuscular junction
Journal
Acta neurologica Belgica
ISSN: 2240-2993
Titre abrégé: Acta Neurol Belg
Pays: Italy
ID NLM: 0247035
Informations de publication
Date de publication:
11 Oct 2024
11 Oct 2024
Historique:
received:
21
02
2024
accepted:
02
10
2024
medline:
11
10
2024
pubmed:
11
10
2024
entrez:
11
10
2024
Statut:
aheadofprint
Résumé
Hypermagnesemia is a rare but potentially fatal electrolyte disorder. High serum magnesium levels have been associated with the development of neurological manifestations such as dysautonomia, muscle weakness, respiratory failure, and altered level of consciousness from drowsiness to coma. Although rare, some subjects, such as those with chronic renal failure and those taking magnesium supplements or medications, are at risk of developing this condition. Recognizing this electrolyte alteration promptly allows for an immediate initiation of a therapeutic strategy that is often resolutive when addressed in time. This paper aims to review the neurological complications associated with hypermagnesemia, their pathophysiology, and management.
Identifiants
pubmed: 39392591
doi: 10.1007/s13760-024-02653-3
pii: 10.1007/s13760-024-02653-3
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.
Références
Mathew AA, Panonnummal R (2021) ‘Magnesium’—the master cation-as a drug—possibilities and evidences. Biometals 34(5):955–986
pubmed: 34213669
pmcid: 8249833
doi: 10.1007/s10534-021-00328-7
Durlach J (1989) Recommended dietary amounts of magnesium: Mg RDA. Magnes Res 2(3):195–203
pubmed: 2701269
Saha H, Harmoinen A, Karvonen AL, Mustonen J, Pasternack A (1998) Serum ionized versus total magnesium in patients with intestinal or liver disease. Clin Chem Lab Med 36(9):715–718
pubmed: 9804396
doi: 10.1515/CCLM.1998.126
Van Laecke S (2019) Hypomagnesemia and hypermagnesemia. Acta Clin Belg 74(1):41–47
pubmed: 30220246
doi: 10.1080/17843286.2018.1516173
Jahnen-Dechent W, Ketteler M (2012) Magnesium basics. Clin Kidney J 5(Suppl 1):i3–i14
pubmed: 26069819
pmcid: 4455825
doi: 10.1093/ndtplus/sfr163
Ferment O, Touitou Y (1985) Magnesium: metabolism and hormonal regulation in different species. Comp Biochem Physiol A Comp Physiol 82(4):753–758
pubmed: 14570081
doi: 10.1016/0300-9629(85)90478-5
Touyz RM (2008) Transient receptor potential melastatin 6 and 7 channels, magnesium transport, and vascular biology: implications in hypertension. Am J Physiol Heart Circ Physiol 294(3):H1103–H1118
pubmed: 18192217
doi: 10.1152/ajpheart.00903.2007
Elin RJ (1988) Magnesium metabolism in health and disease. Dis Mon 34(4):161–218
pubmed: 3282851
doi: 10.1016/0011-5029(88)90013-2
Curry JN, Yu ASL (2018) Magnesium handling in the kidney. Adv Chronic Kidney Dis 25(3):236–243
pubmed: 29793662
pmcid: 6932629
doi: 10.1053/j.ackd.2018.01.003
Seo JW, Park TJ (2008) Magnesium metabolism. Electrolyte Blood Press 6(2):86–95
pubmed: 24459527
pmcid: 3894481
doi: 10.5049/EBP.2008.6.2.86
Oliveira B, Cunningham J, Walsh SB (2018) Magnesium balance in chronic and end-stage kidney disease. Adv Chronic Kidney Dis 25(3):291–295
pubmed: 29793669
doi: 10.1053/j.ackd.2018.01.004
Macías Ruiz MC, Cuenca Bermejo L, Veronese N, Fernández Villalba E, González Cuello AM, Kublickiene K et al (2023) Magnesium in kidney function and disease—implications for aging and sex—a narrative review. Nutrients 15(7):1710
pubmed: 37049550
pmcid: 10097335
doi: 10.3390/nu15071710
Kirkland AE, Sarlo GL, Holton KF (2018) The role of magnesium in neurological disorders. Nutrients 10(6):730
Maier JAM, Locatelli L, Fedele G, Cazzaniga A, Mazur A (2023) Magnesium and the brain: a focus on neuroinflammation and neurodegeneration. Int J Mol Sci 24(1):223
doi: 10.3390/ijms24010223
Shi J, Krishnamoorthy G, Yang Y, Hu L, Chaturvedi N, Harilal D et al (2002) Mechanism of magnesium activation of calcium-activated potassium channels. Nature 418(6900):876–880
pubmed: 12192410
doi: 10.1038/nature00941
Romeo V, Cazzaniga A, Maier JAM (2019) Magnesium and the blood–brain barrier in vitro: effects on permeability and magnesium transport. Magnes Res 32(1):16–24
pubmed: 31503002
Wang H, Liang Q-S, Cheng L-R, Li X-H, Fu W, Dai W-T et al (2011) Magnesium sulfate enhances non-depolarizing muscle relaxant vecuronium action at adult muscle-type nicotinic acetylcholine receptor in vitro. Acta Pharmacol Sin 32(12):1454–1459
pubmed: 21986576
pmcid: 4010211
doi: 10.1038/aps.2011.117
Potter JD, Robertson SP, Johnson JD (1981) Magnesium and the regulation of muscle contraction. Fed Proc 40(12):2653–2656
pubmed: 7286246
Myrdal U, Leppert J, Edvinsson L, Ekman R, Hedner T, Nilsson H et al (1994) Magnesium sulphate infusion decreases circulating calcitonin gene-related peptide (CGRP) in women with primary Raynaud’s phenomenon. Clin Physiol 14(5):539–546
pubmed: 7820978
doi: 10.1111/j.1475-097X.1994.tb00412.x
Pochwat B, Sowa-Kucma M, Kotarska K, Misztak P, Nowak G, Szewczyk B (2015) Antidepressant-like activity of magnesium in the olfactory bulbectomy model is associated with the AMPA/BDNF pathway. Psychopharmacology 232(2):355–367
pubmed: 25027582
doi: 10.1007/s00213-014-3671-6
Xu ZP, Li L, Bao J, Wang ZH, Zeng J, Liu EJ et al (2014) Magnesium protects cognitive functions and synaptic plasticity in streptozotocin-induced sporadic Alzheimer’s model. PLoS ONE 9(9):e108645
pubmed: 25268773
pmcid: 4182554
doi: 10.1371/journal.pone.0108645
Yamanaka R, Shindo Y, Oka K (2019) Magnesium is a key player in neuronal maturation and neuropathology. Int J Mol Sci 20(14):3439
pubmed: 31336935
pmcid: 6678825
doi: 10.3390/ijms20143439
De las Peñas R, Escobar Y, Henao F, Blasco A, Rodríguez CA (2014) SEOM guidelines on hydroelectrolytic disorders. Clin Transl Oncol 16(12):1051–1059
pubmed: 25304221
pmcid: 4239780
doi: 10.1007/s12094-014-1234-2
Aal-Hamad AH, Al-Alawi AM, Kashoub MS, Falhammar H (2023) Hypermagnesemia in clinical practice. Medicina (Kaunas) 59(7)
Hutter OF, Kostial K (1954) Effect of magnesium and calcium ions on the release of acetylcholine. J Physiol 124(2):234–241
pubmed: 13175126
pmcid: 1366261
doi: 10.1113/jphysiol.1954.sp005102
Del Castillo J, Engbaek L (1954) The nature of the neuromuscular block produced by magnesium. J Physiol 124(2):370–384
pubmed: 13175138
pmcid: 1366273
doi: 10.1113/jphysiol.1954.sp005114
Krendel DA (1990) Hypermagnesemia and neuromuscular transmission. Semin Neurol 10(1):42–45
pubmed: 2161126
doi: 10.1055/s-2008-1041252
Fishman RA (1965) Neurological aspects of magnesium metabolism. Arch Neurol 12(6):562–569
pubmed: 14295956
doi: 10.1001/archneur.1965.00460300010002
Somjen G, Hilmy M, Stephen CR (1966) Failure to anesthetize human subjects by intravenous administration of magnesium sulfate. J Pharmacol Exp Ther 154(3):652–659
pubmed: 5928261
Alfrey AC, Terman DS, Brettschneider L, Simpson KM, Ogden DA (1970) Hypermagnesemia after renal homotransplantation. Ann Intern Med 73(3):367–371
pubmed: 4917178
doi: 10.7326/0003-4819-73-3-367
Bansal AD, Negoianu D, Warburton KM (2016) An unusual yet “Mg”nificent indication for hemodialysis. Semin Dial 29(3):247–250
pubmed: 26915350
pmcid: 5492508
doi: 10.1111/sdi.12479
Birrer RB, Shallash AJ, Totten V (2002) Hypermagnesemia-induced fatality following epsom salt gargles(1). J Emerg Med 22(2):185–188
pubmed: 11858925
doi: 10.1016/S0736-4679(01)00462-0
Hashizume N, Mori M (1990) An analysis of hypermagnesemia and hypomagnesemia. Jpn J Med 29(4):368–372
pubmed: 2273620
doi: 10.2169/internalmedicine1962.29.368
Morimatsu M, Ono K, Harada A (2021) Severe asterixis due to hypermagnesemia in chronic renal failure: a case report. Neurol Sci 42(6):2539–2542
pubmed: 33404861
pmcid: 8159814
doi: 10.1007/s10072-020-04945-x
Qureshi T, Melonakos TK (1996) Acute hypermagnesemia after laxative use. Ann Emerg Med 28(5):552–555
pubmed: 8909278
doi: 10.1016/S0196-0644(96)70120-8
Randall RE Jr, Cohen MD, Spray CC Jr, Rossmeisl EC (1964) Hypermagnesemia in renal failure. Etiology and toxic manifestations. Ann Intern Med 61:73–88
pubmed: 14178364
doi: 10.7326/0003-4819-61-1-73
Rizzo MA, Fisher M, Lock JP (1993) Hypermagnesemic pseudocoma. Arch Intern Med 153(9):1130–1132
pubmed: 8481079
doi: 10.1001/archinte.1993.00410090072009
Rodis JF, Vintzileos AM, Campbell WA, Deaton JL, Nochimson DJ (1987) Maternal hypothermia: an unusual complication of magnesium sulfate therapy. Am J Obstet Gynecol 156(2):435–436
pubmed: 3826181
doi: 10.1016/0002-9378(87)90300-0
Walker P, Parnell S, Dillon RC (2020) Epsom salt ingestion leading to severe hypermagnesemia necessitating dialysis. J Emerg Med 58(5):767–770
pubmed: 32389435
doi: 10.1016/j.jemermed.2020.04.023
Weng YM, Chen SY, Chen HC, Yu JH, Wang SH (2013) Hypermagnesemia in a constipated female. J Emerg Med 44(1):e57-60
pubmed: 22244603
doi: 10.1016/j.jemermed.2011.09.004
Yamaguchi H, Shimada H, Yoshita K, Tsubata Y, Ikarashi K, Morioka T et al (2019) Severe hypermagnesemia induced by magnesium oxide ingestion: a case series. CEN Case Rep 8(1):31–37
pubmed: 30136128
doi: 10.1007/s13730-018-0359-5
Chakurkar VV, Gade PS, Godbole AV, Wadia FF, Lobo VA (2019) Inadvertently high dialysate magnesium causing weakness and nausea in hemodialysis patients. Hemodial Int 23(4):E106–E110
pubmed: 31115142
doi: 10.1111/hdi.12763
Bokhari SR, Siriki R, Teran FJ, Batuman V (2018) Fatal hypermagnesemia due to laxative use. Am J Med Sci 355(4):390–395
pubmed: 29661354
doi: 10.1016/j.amjms.2017.08.013
Morisaki H, Yamamoto S, Morita Y, Kotake Y, Ochiai R, Takeda J (2000) Hypermagnesemia-induced cardiopulmonary arrest before induction of anesthesia for emergency cesarean section. J Clin Anesth 12(3):224–226
pubmed: 10869923
doi: 10.1016/S0952-8180(00)00142-2
Yamamoto N, Oh E, Yoshikawa A, Takai M, Yoshida M, Saeki A et al (2018) Hypothyroidism-induced hypermagnesemia with a small dose of magnesium. Geriatr Gerontol Int 18(9):1420–1421
pubmed: 30240541
doi: 10.1111/ggi.13485
Kikuchi T, Kumakura S, Tanabe Y (2010) Perioperative management for a patient with hypermagnesemia-induced shock with perforative peritonitis. J Anesth 24(3):479–481
pubmed: 20333415
doi: 10.1007/s00540-010-0909-2
Nishikawa M, Shimada N, Kanzaki M, Ikegami T, Fukuoka T, Fukushima M et al (2018) The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis. Acute Med Surg 5(3):222–229
pubmed: 29988705
pmcid: 6028801
doi: 10.1002/ams2.334
Yeh CY, Lee SW, Chuang TY, Jong YS, Chen WJ (2008) Junctional bradycardia due to cathartic-a rare presentation of hypermagnesaemia in emergency department. Resuscitation 79(3):509–511
pubmed: 18952351
doi: 10.1016/j.resuscitation.2008.08.006
Tofil NM, Benner KW, Winkler MK (2005) Fatal hypermagnesemia caused by an Epsom salt enema: a case illustration. South Med J 98(2):253–256
pubmed: 15759964
doi: 10.1097/01.SMJ.0000145307.80421.4B
Kikuchi K, Tanaka H, Gima M, Kashiwagi Y, Shida H, Kawamura Y et al (2012) Abnormalities of magnesium (Mg) metabolism and therapeutic significance of Mg administration in patients with metabolic syndrome, type 2 diabetes, heart failure and chronic hemodialysis. Clin Calcium 22(8):1217–1226
pubmed: 22846358
McGuire JK, Kulkarni MS, Baden HP (2000) Fatal hypermagnesemia in a child treated with megavitamin/megamineral therapy. Pediatrics 105(2):E18
pubmed: 10654978
doi: 10.1542/peds.105.2.e18
Ali A, Walentik C, Mantych GJ, Sadiq HF, Keenan WJ, Noguchi A (2003) Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports. Pediatrics 112(1 Pt 1):e70–e72
pubmed: 12837909
doi: 10.1542/peds.112.1.e70
Swift TR (1979) Weakness from magnesium-containing cathartics: electrophysiologic studies. Muscle Nerve 2(4):295–298
pubmed: 492206
doi: 10.1002/mus.880020409
Thwaites CL, Yen LM, Loan HT, Thuy TT, Thwaites GE, Stepniewska K et al (2006) Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet 368(9545):1436–1443
pubmed: 17055945
doi: 10.1016/S0140-6736(06)69444-0
Kesner VG, Oh SJ, Dimachkie MM, Barohn RJ (2018) Lambert–Eaton myasthenic syndrome. Neurol Clin 36(2):379–394
pubmed: 29655456
pmcid: 6690495
doi: 10.1016/j.ncl.2018.01.008
Gutierrez AR, Bodensteiner J, Gutmann L (1994) Electrodiagnosis of infantile botulism. J Child Neurol 9(4):362–365
pubmed: 7822724
doi: 10.1177/088307389400900404
Castelbaum AR, Donofrio PD, Walker FO, Troost BT (1989) Laxative abuse causing hypermagnesemia, quadriparesis, and neuromuscular junction defect. Neurology 39(5):746–747
pubmed: 2710370
doi: 10.1212/WNL.39.5.746-a
Bashuk RG, Krendel DA (1990) Myasthenia gravis presenting as weakness after magnesium administration. Muscle Nerve 13(8):708–712
pubmed: 2385256
doi: 10.1002/mus.880130808
Lim MK (1969) Experience with serum magnesium estimations. Med J Aust 1(21):1075–1077
pubmed: 5792704
doi: 10.5694/j.1326-5377.1969.tb49906.x
Nordt SP, Williams SR, Turchen S, Manoguerra A, Smith D, Clark RF (1996) Hypermagnesemia following an acute ingestion of Epsom salt in a patient with normal renal function. J Toxicol Clin Toxicol 34(6):735–739
pubmed: 8941206
doi: 10.3109/15563659609013838
Araki K, Kawashima Y, Magota M, Shishida N (2021) Hypermagnesemia in a 20-month-old healthy girl caused by the use of a laxative: a case report. J Med Case Rep 15(1):129
pubmed: 33750439
pmcid: 7944606
doi: 10.1186/s13256-021-02686-9
Yoon HE, Kim YW, Ha KS, Sim EH, Go SW, Shin SJ (2013) Hypermagnesemia accompanied with colonic perforation in a hemodialysis patient. Yonsei Med J 54(3):797–800
pubmed: 23549833
pmcid: 3635627
doi: 10.3349/ymj.2013.54.3.797
Sawalha K, Kakkera K (2020) Acute respiratory failure from hypermagnesemia requiring prolonged mechanical ventilation. J Investig Med High Impact Case Rep 8:2324709620984898
pubmed: 33371745
pmcid: 7783877
doi: 10.1177/2324709620984898
Deshpande GG, Gharpure V, Sarnaik AP, Valentini RP (2006) Acute hypermagnesemia in a child. Am J Health Syst Pharm 63(3):262–265
pubmed: 16434786
doi: 10.2146/ajhp050319
Harker HE, Majcher TA (2000) Hypermagnesemia in a pediatric patient. Anesth Analg 91(5):1160–1162
pubmed: 11049902
Naksuk N, Hu T, Krittanawong C, Thongprayoon C, Sharma S, Park JY et al (2017) Association of serum magnesium on mortality in patients admitted to the intensive cardiac care unit. Am J Med 130(2):229.e5-229.e13
pubmed: 27639872
doi: 10.1016/j.amjmed.2016.08.033
Lai X, Chen W, Bian X, Wang T, Li J, Wang H et al (2015) Predictors of poor sleep quality and excessive daytime sleepiness in peritoneal dialysis patients. Ren Fail 37(1):61–65
pubmed: 25224151
doi: 10.3109/0886022X.2014.959431
Yang Y, Ye H, He Q, Zhang X, Yu B, Yang J et al (2019) Association between predialysis hypermagnesaemia and morbidity of uraemic restless legs syndrome in maintenance haemodialysis patients: a retrospective observational study in Zhejiang, China. BMJ Open 9(7):e027970
pubmed: 31292178
pmcid: 6624039
doi: 10.1136/bmjopen-2018-027970
Ghoneim MM, Long JP (1970) The interaction between magnesium and other neuromuscular blocking agents. Anesthesiology 32(1):23–27
pubmed: 5460601
doi: 10.1097/00000542-197001000-00007
Na HS, Lee JH, Hwang JY, Ryu JH, Han SH, Jeon YT et al (2010) Effects of magnesium sulphate on intraoperative neuromuscular blocking agent requirements and postoperative analgesia in children with cerebral palsy. Br J Anaesth 104(3):344–350
pubmed: 20042475
doi: 10.1093/bja/aep379
Cascella M, Vaqar S (2023) Hypermagnesemia. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Sarosh Vaqar declares no relevant financial relationships with ineligible companies. StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.
Vissers RJ, Purssell R (1996) Iatrogenic magnesium overdose: two case reports. J Emerg Med 14(2):187–191
pubmed: 8740750
doi: 10.1016/0736-4679(95)02115-9
Premkumar CR, Parthasarathy R, Kumar S, Vijaykumar S (2022) Postoperative respiratory depression caused by iatrogenic hypermagnesaemia. Anaesth Rep 10(1):e12154
pubmed: 35360363
pmcid: 8948459
doi: 10.1002/anr3.12154