Management of Severe Hypermagnesemia

Indications for Dialysis

• The American Heart Association recommends considering dialysis in cardiac arrest associated with hypermagnesemia, particularly when empirical calcium administration does not reverse cardiotoxicity, in patients with severe symptoms 1, 2
• The American College of Cardiology suggests that severe symptomatic hypermagnesemia with hemodynamic instability warrants dialysis when calcium and fluid therapy are ineffective, although the strength of evidence is not specified 1, 2
• Obstetric patients receiving high-dose magnesium sulfate for preeclampsia/eclampsia who develop toxicity should be considered for dialysis, according to the American College of Obstetricians and Gynecologists 2

Standard Treatment Algorithm

Immediate Supportive Measures

• The American Heart Association recommends administering intravenous calcium gluconate (10% solution, 15-30 mL) or calcium chloride (10% solution, 5-10 mL) over 2-5 minutes as a direct antagonist to magnesium's cardiac and neuromuscular effects, with a strength of evidence rated as high 1, 2