Treatment of Hypermagnesemia

Clinical Management

For hypermagnesemia causing cardiac arrest or severe cardiotoxicity, immediately administer intravenous calcium (calcium chloride 10% 5-10 mL OR calcium gluconate 10% 15-30 mL IV over 2-5 minutes) as the primary antidote, while simultaneously discontinuing all magnesium sources and initiating dialysis for severe cases, as recommended by the American Heart Association 1, 2, 3
Neurological symptoms of moderate hypermagnesemia (>2.2 mEq/L) include muscular weakness, paralysis, ataxia, drowsiness, and confusion, according to the American College of Cardiology 1, 2, 3
Cardiovascular manifestations of moderate hypermagnesemia (>2.2 mEq/L) include vasodilation and hypotension, as stated by the American Heart Association 1, 2, 3
Severe hypermagnesemia (>6 mEq/L) can cause depressed level of consciousness, bradycardia, cardiac arrhythmias, hypoventilation, and cardiorespiratory arrest, as reported by the American College of Cardiology 1, 2, 3
The target normal magnesium range is 1.3-2.2 mEq/L, as recommended by the American Heart Association 1, 2, 3

The American Society of Nephrology recommends avoiding magnesium-containing preparations in patients with acute or chronic kidney disease, bowel obstruction, or severe constipation, as well as elderly patients with multiple comorbidities, to prevent hypermagnesemia 4
When magnesium-containing laxatives are used, the European Society of Medical Oncology suggests ensuring adequate renal function and avoiding prolonged use to minimize the risk of hypermagnesemia 4