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      Severe Symptomatic Hypermagnesemia Associated with Over-the-Counter Laxatives in a Patient with Renal Failure and Sigmoid Volvulus

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          Abstract

          Hypermagnesemia is an uncommon but a potentially serious clinical condition. Over-the-counter magnesium containing products are widely used as antacids or laxatives. Although generally well tolerated in patients with normal renal function, their unsupervised use in the elderly can result in severe symptomatic hypermagnesemia, especially in those patients with concomitant renal failure and bowel disorders. We report a case of severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a 70-year-old male patient with renal failure and sigmoid volvulus, who was successfully treated with hemodialysis.

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          Most cited references10

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          Magnesium in cell proliferation and differentiation.

          Compelling evidence shows that magnesium (Mg) content is directly correlated to proliferation in normal cells as Mg stimulates DNA and protein synthesis. Some data have demonstrated that upon mitogenic stimuli normal cell are able to increase their intracellular Mg content, likely by activating Mg influx. Mg deprivation, in turn, induces inhibition of DNA and protein synthesis thus promoting growth arrest. From a mechanistic viewpoint, Mg deprivation may influence cell cycle control by upregulating the cyclin inhibitor p27Kip1 thus influencing cyclin E-dependent kinases. In many neoplastic cells, Mg is higher than in normal counterparts and this high Mg is maintained also against concentration gradient. Moderate vs. severe and acute vs chronic effect of Mg deprivation must be distinguished: severe Mg deprivation causes growth arrest also in tumor cells, while chronic Mg deprivation leads to an "adaptation" of tumor cells both to growth rate and Mg content. In tumor cells deranged Mg content and distribution is likely due to an inhibition of Mg efflux via the Na-Mg antiport. When differentiation process is induced by receptor mediated stimuli such as IFN-alpha and ATP, decrease of cell Mg content accompanies with activation of Mg efflux. Transformed cells may thus display high growth rate also because they retain a large amount of Mg. On their whole, these data strongly suggest that regulation of intracellular Mg availability parallels the molecular control of cell proliferation, and maybe also cell differentiation and death.
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            Excess magnesium.

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              Iatrogenic magnesium overdose: two case reports.

              We report two cases of iatrogenic intravenous magnesium overdose. Both patients presented to the emergency department in alcohol withdrawal, and during the course of their therapy were ordered to receive 2 g of magnesium sulfate intravenously. The patients were erroneously given 20 g of magnesium sulfate, causing cardiac arrest in both cases. The patients were both successfully resuscitated. One patient was discharged neurologically intact and the other died three days later. Review of the literature identified one previous report of iatrogenic overdose of intravenous magnesium causing death. Hypermagnesemia is a rare occurrence, particularly in the absence of renal failure. The cause is often iatrogenic. The major life-threatening clinical manifestations are cardiac conduction delays, asystole, apnea, and coma. A particular hazard of intravenous magnesium therapy is the variety of units of measurement used in written orders and on drug labels. This can easily lead to errors in drug administration.
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                Author and article information

                Journal
                Case Rep Nephrol
                Case Rep Nephrol
                CRIM.NEPHROLOGY
                Case reports in nephrology
                Hindawi Publishing Corporation
                2090-6641
                2090-665X
                2014
                6 January 2014
                : 2014
                : 560746
                Affiliations
                1Department of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA
                2Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA
                Author notes

                Academic Editors: R. Enríquez, Y. Fujigaki, P. C. Pham, and H. Trimarchi

                Article
                10.1155/2014/560746
                3914018
                5fe62157-bbae-4323-926f-5311164196d7
                Copyright © 2014 Talal Khairi et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 September 2013
                : 22 October 2013
                Categories
                Case Report

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