Abstract: FR-PO229
Hemodialysis Is More Effective Than Continuous Venovenous Hemodialysis for Treatment of Hypermagnesemia due to Epsom Salt Ingestion
Session Information
- Pharmacology
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)
- 1900 Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)
Authors
- Bashtawi, Yazan Ali, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Ayub, Fatima, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Holthoff, Joseph H., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Introduction
A case of AKI on CKD and hypermagnesemia due to Epsom salt (MgSO4) ingestion
Case Description
73 year old male with chroinc kidney disease stage 3a who was in chronic use of laxatives presented to ER with generalized weakness associated with hot flushes, nausea and vomiting. He had poor oral Intake for several weeks. He takes two tablespoons of Epsom salts daily for constipation, and recently doubled the dose. On arrival vitals showed BP 128/93, P 76, RR 16, O2 sat 94 %, T 97.5, BMI 15. He had diffuse hyporeflexia.Creatinine (Cr) 3.3 mg/dl;calcium (Ca) 8 mg/dl; Magnesium (Mg) 10.8 mg/dl. PH 7.12, PaCO2 28 mmHg,HCO3 9 mmol/l Table1.Urine output >2L/day. Glucose, CK, lactate, ALT, AST,TSH and troponin were normal. ECG showed sinus rhythm (SR), prolonged PR,QRS and QTC intervals. 2 L lactated Ringer's, 4 grams (g) IV Ca gluconate, Lasix 80 mg IV, 40 mEq of potassium chloride IV, and 40 mEq oral were given. 2 hours (hrs) later Mg was 10.4 mg/dl. Patient was shifted to ICU. Treatment repeated and 150 ml/hr normal saline added. 8 hrs later Mg 8.1 mg/dl. ECG showed junctional rhythm. Hemodialysis (HD) was initated for 3 hrs (Mg 1 mEq/L,4 k path). Post HD Mg 3.7 mg/dl. For concerns of rebound hypermagnesemia, Continuous Venovenous Hemodialysis (CVVHD) was started (4 k, Mg 1 mEq/L path, rate 25 ml/kg/hr, continuous 30 mmol potassium phosphate infusion every 12 hrs). 18 hrs later his Mg improved to 2.9 mg/dl and treatment terminated figure 1.ECG showed SR with normal PR and QTC intervals. Generalizd weakness and hyporeflexia were resolved.He was discharged home 4 days later with baseline Cr and Mg 2.1 mg/dl
Discussion
Intermittent hemodialysis resulted in more rapid Mg removal in this patient with renal failure Figure1. CVVHD may be used as a adjunct therapy for prevention of rebound hypermagnesemia especially when prolonged GI release of ingested magnesium compounds is expected