ACUTE RESPIRATORY FAILURE FROM HYPERMAGNESEMIA REQUIRING PROLONGED MECHANICAL VENTILATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Magnesium is a major intra-cellular divalent cation. It essential for multiple metabolic and physiological processes. plays crucial role in enzymatic actions, electron transporters, the synthesis of nucleic acids. CASE PRESENTATION: A 73-year-old Caucasian male patient with past medical history Hypertension, Diabetes Mellitus type two, chronic constipation lower back pain presented to emergency department 2-day diffuse abdominal pain. Acute series failed show significant abnormality other than hence he was given one dose oral magnesium citrate, GI cocktail (contains Maalox) fleets enema on day hospital stay. Overnight had near syncopal episode worsening his while having bowel movement. He noted be hypotensive blood pressure 84/47 mmhg, heart rate 132 lactic acidosis level 8.3 mmol/l, an abdominopelvic CT done showed free air abdomen (Figures 1 2). Patient taken emergent laparotomy underwent pyloric ulcer perforation repair omental patch.On post-operative have flaccid paralysis including lack deep tendon brain stem refluxes. Due concerns anoxic injury, imaging no acute findings. Ionized Calcium, Phosphate levels Potassium were within normal limits. 9.2 mg/dl. This thought cause initiated Intravenous fluids along Lasix. In view oliguric kidney Hemodialysis initiated. received two hemodialysis sessions returning physiologic levels. Over next 48-72 hours has improvement hypotension bradycardia. His mentation muscle strength injury also improved. successfully liberated from ventilator subsequently discharged rehab DISCUSSION: Our respiratory failure extubate due muscles. found result extremely high serum which unexpected only doses containing agents (magnesium citrate last 2 weeks. Hypermagnesemia most commonly seen setting renal impairment concomitant excessive intake. Neuromuscular cardiac toxicity are common complications hypermagnesemia. [2] all features usually described hypermagnesmia but small intake injury. We hypothesize that allowed increased uptake through inflamed peritoneum CONCLUSIONS: N/A REFERENCE #1: Cascella, Marco, Sarosh Vaqar et al. "Hypermagnesemia." StatPearls, StatPearls Publishing, 2020. #2: Agus, Z. S., M. Morad "Modulation ion channels by magnesium." Annual review physiology 53.1 (1991):299-307. #3: Lee, Jay Wook. "Fluid electrolyte disturbances critically ill patients." Electrolytes & Blood Pressure 8.2 (2010):72-81. DISCLOSURES: No relevant relationships Khalid Sawalha, source=Web Response