Case; 58 years old male with End Stage Renal Disease (ESRD) on scheduled hemodialysis is brought from home with somnolence. Neuro exam is consistent with loss of deep tendon reflexes, flaccid quadriplegia, and decreased respiration requiring intubation. Also, pupils appear fixed and dilated pupils - diagnosed by neurology service as hypermagnesemic pseudocoma. Serum Magnesium level is reported to be 14 mEq/L. Family reports use of over-the-counter enema in last few days for constipation.
Answer: Magnesium toxicity from mаgnesium based enema
A clinically and potentially fatal amount of mаgոеѕium can be absorbed from the large bowel following mаgnesium enemas, particularly in renal patients. Even in healthy people, 400 to 800 mmol of magnesium sulfate per rectum can increase the plasma magոеsium level to as high as 16 mEq/L.
#toxicology
#nephrology
References:
1. Schelling JR. Fatal hypermagnesemia. Clin Nephrol 2000; 53:61.
2. Rizzo MA, Fisher M, Lock JP. Hypermagnesemic pseudocoma. Arch Intern Med 1993; 153:1130.
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