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Clinical features: Hypermagnesaemia may occur when large doses of magnesium are given, especially in patients with renal failure. Signs of hypermagnesaemia include: nausea, vomiting, flushing, hypotension, muscle weakness, muscle paralysis, blurred or double vision, CNS depression and loss of reflexes. More severe hypermagnesaemia may result in respiratory depression, respiratory paralysis, renal failure, coma, cardiac arrhythmias and cardiac arrest.
Disappearance of the patellar reflex is a useful clinical sign to detect the onset of magnesium intoxication.
Treatment: In the treatment of hypermagnesaemia, the following measures may be required: blood pressure and respiratory support; intravenous administration of 2.5 to 10 mmol calcium salts (such as calcium gluconate) reverses the effects of magnesium toxicity; dialysis may be required, particularly if renal function is impaired; if renal function is normal, adequate fluids should be given so that urine output is at least 60 mL/hr to assist removal of magnesium from the body; physostigmine (0.5 to 1.0 mg subcutaneously) may be helpful, but routine use is not recommended due to the potential toxicity; hypermagnesemia in the new born may require resuscitation and assisted ventilation as well as IV calcium.
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