Hypermagnesemia and Hypomagnesemia

Hypermagnesemia and Hypomagnesemia Nursing Care Plans Diagnosis and Interventions

Hypermagnesemia and Hypomagnesemia NCLEX Review Care Plans

Nursing Study Guide on Hypermagnesemia and Hypomagnesemia

Magnesium is an essential electrolyte in the body. It plays a role in maintaining nerve, cardiovascular, and muscular functions. It also supports the immune system and maintains bone strength.

Magnesium in the blood is mainly regulated by the gastrointestinal and renal systems, while excess magnesium is stored in the bones. Absorption is controlled by the gastrointestinal system, while excretion is regulated by the renal system by way of urine.

Nursing Stat Facts

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Nursing Stat Facts

The normal magnesium level in the blood is between 1.7-2.3mg/dL. Serum magnesium levels above 2.3mg/dL would be considered hypermagnesemia, and levels below 1.7mg/dL would be considered hypomagnesemia. Both hypo and hypermagnesemia are electrolyte imbalances and may result in various complications.

Signs and Symptoms of Hypermagnesemia and Hypomagnesemia

Hypermagnesemia and hypomagnesemia both produce various symptoms. Extreme highs and lows may lead to heart problems, seizures, difficulty breathing, shock, and in severe cases, coma.

  • Hypermagnesemia
    • Nausea and vomiting
    • Neurological impairment
    • Hypotension
    • Flushing
    • Headache
    • Hyporeflexia
    • Respiratory depression
  • Hypomagnesemia
    • Twitches, especially in facial muscles
    • Symptoms of hypocalcemia
    • Weakness, fatigue
    • Nausea and vomiting
    • Tremors
    • Personality changes
    • Pronounced reflexes
    • Constipation
    • Muscle contractions
    • Seizures
    • Arrhythmias such as atrial fibrillation and ventricular arrhythmias

Causes of Hypermagnesemia and Hypomagnesemia

Magnesium has a close relationship with calcium. When calcium levels are low, the parathyroid releases the parathyroid hormone for calcium to be released.

Magnesium is vital in this process as it is required for the parathyroid hormone to be produced. Once a patient develops hypomagnesemia, he/she will also subsequently develop hypocalcemia symptoms if the magnesium is not corrected immediately.

Cardiovascular-wise, magnesium competes with calcium and helps in the relaxation of the heart muscle cell, stimulating contractions. These electrolytes ensure that the heart contracts and relaxes properly. Likewise, if the person has increased or decreased magnesium levels, the heart is also affected.

As it assists in regulating cardiac contractions, if there is an abnormal level of magnesium, the patient may develop arrhythmias, irregular heartbeat, and low blood pressure. Treatment of these conditions is very important as extreme deficiency or excess of this electrolyte may lead to death.

Magnesium deficiency is linked with insulin resistance. Increased intake has been shown to lower the risk of developing type 2 diabetes.

Diabetic persons usually have low magnesium levels, especially if their blood sugar is uncontrolled, as the kidney attempts to clear out the sugar along with the magnesium.

Additional factors are increasing age and the use of diuretics. Increasing age leads to decreased absorption of nutrients and the use of diuretics lead to the increased excretion of fluids and nutrients.

  1. Hypermagnesemia
    • Kidney failure – magnesium builds up due to the inability of the kidneys to function correctly; decreased filtration leads to accumulation of magnesium
    • Malnourishment – overnutrition of magnesium-rich food
    • Alcoholism – heavy alcohol intake causes loss of magnesium from the tissues and accumulation in the blood
    • Lithium therapy – lithium precipitates decreased urinary excretion and eventual accumulation of magnesium
    • Hypothyroidism, Addison’s disease – there is decreased magnesium uptake in the bones in hypothyroidism
    • Magnesium-containing drugs, such as laxatives and antacids
  2. Hypomagnesemia
    • Inadequate intake of magnesium-rich food – examples of such foods are dark chocolate, avocados, nuts, legumes, tofu, seeds, whole grains, bananas, and green leafy vegetables
    • Excess release of magnesium from the kidneys as urine
    • Anorexia, bulimia, frequent vomiting, diarrhea – GI losses include magnesium and several other electrolytes
    • Alcoholism – diuresis is increased with excessive alcohol intake
    • Breast-feeding, pregnancy – increased release of nutrients for the fetus or the breastfed baby leads to decreased nutrients for the mother
    • Age – as age increases, magnesium absorption becomes more difficult
    • Diabetes – high glucose levels in the kidneys may lead to increased magnesium excretion; polyuria may also lead to magnesium deficiency in the diabetic patient
    • Kidney failure – too much magnesium is excreted due to the inability of the kidneys to function correctly; ineffective filtration may lead to increased urinary magnesium losses
    • Diuretics – increased urinary excretion of magnesium if non-magnesium sparing diuretics are used

Complications of Hypermagnesemia and Hypomagnesemia

1. Hypermagnesemia

2. Hypomagnesemia

  • Atrial fibrillation
  • Coronary artery vasospasm
  • Sudden death

Diagnosis of Hypermagnesemia and Hypomagnesemia

The signs and symptoms of hypermagnesemia and hypomagnesemia may be non-indicative. A blood test for electrolytes or an electrolyte panel is the definitive test for hypo and hypermagnesemia. A supporting diagnostic procedure would be an electrocardiogram as tracing abnormalities would be present in electrolyte imbalances.

  • Blood test – blood samples are tested for serum magnesium concentration levels. A blood magnesium level indicating a higher or lower than normal is indicative to make a diagnosis. However, further tests may be requested by doctors to rule out possible causes of the abnormal levels of magnesium.

Normal magnesium levels in adults: 1.7-2.3 mg/dL

  • ECG – changes in the ECG may be noted once the serum magnesium levels of a person reach 6mg/dL. The PR interval becomes prolonged, the QRS complex widens, the T-wave peaks in hypermagnesemia. In hypomagnesemia, the ST segment is depressed, and the T waves are tall.

Treatment for Hypermagnesemia and Hypomagnesemia

Mild cases of hypomagnesemia and hypermagnesemia do not always require treatment. Regular monitoring of magnesium levels and kidney function is commonly the treatment of choice in these instances.

  1. Hypermagnesemia
    • Calcium gluconate. Calcium gluconate is the antidote to magnesium toxicity. It has the ability to reverse magnesium-induced changes in the patient with hypermagnesemia, including respiratory depression.
    • Thiazide diuretics. These medications assist in the excretion of excess magnesium in the patient with hypermagnesemia.
    • Hemodialysis. Magnesium in the blood is not protein-bound and is removable with hemodialysis. Peritoneal dialysis is also an option in patients with hemodynamic compromise.
  2. Hypomagnesemia
    • Magnesium supplementation. Intake of oral magnesium supplements is recommended in cases of low magnesium levels. In severe cases of hypomagnesemia, the patient can be given intravenous magnesium correction.
    • Magnesium-sparing diuretics. Diuretics that preserve magnesium may be indicated.
    • Magnesium-rich food intake. Intake of magnesium-rich foods is indicated for cases of hypomagnesemia. Examples of magnesium-rich foods are dark chocolate, avocados, nuts, legumes, tofu, seeds, whole grains, bananas, and green leafy vegetables.

Nursing Care Plans for Hypermagnesemia and Hypomagnesemia

Nursing Care Plan 1

Nursing Diagnosis: Electrolyte Imbalance related to hypomagnesemia as evidenced by serum calcium level of 0.80 mg/dL, fatigue, muscle weakness, and hyperactive deep tendon reflexes.

Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.

InterventionRationale
Obtain daily blood sample from the patient.Biochemistry is needed to check for the level of serum magnesium.
Encourage the patient to meet the daily recommended intake of dietary magnesium. This includes magnesium-rich foods such as dark chocolate, avocados, nuts, legumes, tofu, seeds, whole grains, bananas, and green leafy vegetables.Intake of magnesium-rich foods is indicated for cases of hypomagnesemia.
 Administer magnesium supplements as prescribed.Intake of oral magnesium supplements is recommended in cases of low magnesium levels.
Consider giving magnesium infusion intravenously as discussed with the medical team.Moderate to severe hypomagnesemia can be corrected by magnesium infusion. Once the serum value is within target range, oral magnesium supplements can be given as prescribed.
Assist the patient in performing activities of daily living as required.Patients with hypomagnesemia usually experience fatigue and body weakness, and therefore may require help in performing ADLs.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to muscular weakness secondary to severe hypomagnesemia, as evidenced by decreased muscular tone, pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs, dysphagia, verbalization of tiredness and generalized weakness

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed  prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.
Assess the patient’s swallowing and refer to the speech and language therapist (SALT) as needed.Patients with hypomagnesemia may experience dysphagia or difficulty of swallowing and may require special assessment from SALT team.

Nursing Care Plan 3

Nursing Diagnosis: Imbalanced Nutrition Less than Body related to hypermagnesemia as evidenced by chronic diarrhea, nausea, vomiting, weakness, loss of appetite, and verbalization of decreased energy levels

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explain to the patient the relation of increased magnesium levels to nausea and vomiting and diarrhea.To help the patient understand why nausea and vomiting associated with diarrhea are signs of hypermagnesemia.
Create a daily weight chart and a food and fluid chart.To effectively monitory the patient’s daily nutritional intake and progress in weight loss goals.
Administer thiazide diuretics as prescribed.Thiazide diuretics promote the excretion of magnesium from the body through the kidneys.
Prepare the patient for hemodialysis if indicated.Magnesium in the blood is not protein-bound and is removable with hemodialysis. Peritoneal dialysis is also an option in patients with hemodynamic compromise.

Nursing Care Plan 4

Impaired Urinary Elimination related hypermagnesemia as evidenced by increase in lab results (BUN, creatinine, uric acid, and eGFR levels), urinary retention, and distended bladder.

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

InterventionsRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern prior to having symptoms of renal injury.To establish baseline data on urinary elimination pattern.
Weigh the patient daily. Commence strict Input and Output monitoring. Note the characteristics of the urine.To assess the fluid volume status of the patient. To check for signs of worsening renal function and perfusion.
Palpate the bladder and observe for bladder distention. Use a bladder scan as needed.To check for bladder distention and urinary retention.
Collect blood samples for renal function tests.To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee.To aid in the recovery of the patient.
Administer thiazide diuretics as prescribed.Thiazide diuretics promote the excretion of magnesium from the body through the kidneys.
Commence strict fluid balance monitoring.To check for the presence of fluid volume excess.
Consider inserting an indwelling catheter.To facilitate accurate monitoring of urinary output.

Other possible nursing diagnosis:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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