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Magnesium Imbalances

Magnesium (1.7 – 2.2 mg/dL)

  • Found in foods like nuts, spinach, avocado, fish, meat, and dairy.
  • Vitamin D enhances absorption.
  • Essential for 
    • > 300 Enzymatic reactions
    • ATP production
    • Muscle contraction & nerve function, prevents hyperexcitability
    • PTH secretion and action
    • Cardiac stability. 
  • Magnesium controls Acetylcholine release at Neuromuscular junction by controlling Calcium entry helping balanced muscle excitability.

Hypermagnesemia(>2.2 mg/dL )

Causes

  • Overuse of magnesium-containing antacids, laxatives, or IV magnesium therapy.
  • Decreased excretion → renal failure or severe kidney impairment prevents Magnesium elimination.

Pathophysiology

     High magnesium suppresses acetylcholine release, leading to neuromuscular depression.

Signs & Symptoms

  • Muscle weakness, loss of reflexes
  • Slow heartbeat, low blood pressure
  • Drowsiness, breathing problems
  • Severe cases: cardiac arrest
  • Caution : No reflexes = emergency

Nursing Management

  1. Monitor the patient’s heart rhythm and breathing closely.
  2. Give IV calcium gluconate (reverses magnesium overdose)
  3. Use loop diuretics with fluids to help the kidneys remove excess magnesium if kidney function is adequate.
  4. Stop all magnesium-containing medications and foods immediately.
  5. If levels are severe or in renal failure, perform dialysis to clear magnesium.

Hypomagnesemia (<1.7 mg/dL)

Causes

  • Inadequate dietary magnesium, malnutrition, alcoholism
  • Malabsorption: celiac, Crohn’s
  • GI or renal losses like Diarrhea or diuretics wash out magnesium.
  • Insulin or high blood sugar move magnesium into cells with glucose and potassium

 Pathophysiology

          Low Magnesium → Increased acetylcholine release causing neuromuscular hyperexcitability & Low PTH causing hypocalcemia.

Signs & Symptoms

  • Muscle cramps, tremors, twitching
  • Overactive reflexes
  • Irregular heartbeat (fast or abnormal)
  • Seizures, confusion
  • Often hypocalcemia

Nursing Management

  1. Cardiac monitoring → watch for arrhythmias.
  2. Oral or IV Magnesium replacement 
  3. Give magnesium slowly and monitor carefully to avoid cardiac depression
  4. Watch for diarrhea with oral magnesium supplements.
  5. Seizure precautions → Side rails, keep airway equipment ready.
  6. Encourage magnesium rich foods
  7. Loss of reflexes during treatment means magnesium overdose.
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