ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: SA-PO706

A Mystery Solved: Getting a "Grip" on Unexplained Hypermagnesemia in a Patient on Continuous Cyclic Peritoneal Dialysis (CCPD)

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Munir, Saba, Rush University Medical Center, Chicago, Illinois, United States
  • Korbet, Stephen M., Rush University Medical Center, Chicago, Illinois, United States
  • Rodby, Roger A., Rush University Medical Center, Chicago, Illinois, United States

Hypermagnesemia should not occur in a patient on RRT without an exogenous source. We present a pt in whom a [Mg] level of 6.0 mg/dL was found in which there was no history of intake of any Mg containing mediations or supplements despite multiple inquiries.

Case Description

A 27 year old black woman with anuric ESKD secondary to Alport's disease on CCPD presented with a 1-wk history of weakness and syncopal episodes. She reported “blackout” and “spacing out" spells, each lasting a few seconds. She also noted new upper extremity weakness, spontaneously dropping items from her hands. She reported compliance with home PD (1.5 mEq/L [Mg] dialysate). She denied use of laxatives or supplements. She works as a chef and denied any recent increase in Mg containing foods.

In the ED her VS were unremarkable except for a BP of 170/90. Her laboratory values were typical for ESKD except for a serum [Mg] of 6.0 mg/dL (nl 1.7-2.7). Her EKG demonstrated a prolonged QTc. She received IV calcium, and her QTc normalized. She was admitted to the hospital and started on rapid exchange PD with a dialysate [Mg] of 0.5 mEq/L. Her neurologic episodes and muscular weakness resolved. Upon further investigation (by the dietician), the patient noted that she recently started rock climbing 4 times per week using climber’s chalk to improve her grip (the chalk helps keep hands dry to provide a stronger grip) which upon research was found to be made of magnesium carbonate (Figure 1). Her [Mg] improved in the hospital and decreased further at home with change to a lower [Mg] dialysate and stopping her rock climbing (Fig. 1).


Magnesium is easily excreted by the kidneys when renal function is normal, so hypermagnesemia requires a large exogenous source in the setting of renal insufficiency. The exact mechanism by which she absorbed Mg from the climbing chalk remains uknown. Although a dialysate [Mg] of 1.5 mEq/L (0.75 mmol/L) is slightly high relative to a normal serum [Mg], her markedly elevated [Mg] of 6.0 mg/dL (2.5 mmol/L) had to be from an exogenous source that required “Dr. House” like investigation to solve.

Figure 1. Clinical course of magnesium