SHM Converge Scientific Abstract ePoster Gallery-Severe Symptomatic Hypermagnesemia Following Bowel Perforation

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This case describes a 77-year-old man with Parkinson’s disease who developed severe symptomatic hypermagnesemia after bowel perforation occurred during large bowel obstruction decompression. He had been taking magnesium hydroxide laxatives for a week for constipation. After the perforation, he rapidly became bradycardic, hypotensive, flaccid, and developed a right bundle branch block. Laboratory testing showed a critically elevated magnesium level of 13 mg/dL despite normal renal function.<br /><br />He was treated with intravenous crystalloid fluids and loop diuretics, which lowered his magnesium level over several hours. His symptoms resolved once serum magnesium fell below 6 mg/dL. Calcium gluconate and dialysis are also recognized treatment options in severe cases.<br /><br />The report emphasizes that symptomatic hypermagnesemia is uncommon but can be life-threatening. It is often associated with magnesium-containing laxatives, especially in patients with chronic kidney disease. However, this case suggests that bowel perforation may also contribute by allowing peritoneal absorption of magnesium, leading to rapid toxicity even without renal impairment.<br /><br />Overall, the case highlights the need to consider hypermagnesemia in patients with unexplained cardiovascular and neuromuscular collapse, particularly when there is recent magnesium laxative use or gastrointestinal injury. Early recognition and prompt treatment with fluids, diuresis, calcium, and/or dialysis are essential to prevent fatal outcomes.

Asset Subtitle

Adam I. Rifaat

Meta Tag

Author List Adam I. Rifaat, Julia Lim

Category Clinical Vignettes

Concept Hypermagnesemia

Concept Bradycardia

Concept Hypotension

Concept Bowel Perforation

Concept Calcium Gluconate

Distinguished Non-Finalist

Presenter Organization Womack Army Medical Center

Presenting Author Adam I. Rifaat

Track Adult

Keywords

hypermagnesemia

magnesium hydroxide laxatives

bowel perforation

large bowel obstruction

Parkinson’s disease

bradycardia

hypotension

right bundle branch block

magnesium toxicity

intravenous fluids

Hypermagnesemia

Bradycardia

Hypotension

Bowel Perforation

Calcium Gluconate