The patient was brought to a room and placed on the monitor, which showed a wide complex tachycardia. An EKG obtained at triage (Figure 1) showed sinus rhythm with first degree AV block and peaked T-waves. Initial vital signs were grossly unremarkable. Her history is significant for ESRD and she missed dialysis today. 14.A 60-year-old female presents to the ED with worsening generalized weakness and SOB over the past 3 days. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. European Society of Cardiology Committee for Practice Guidelines. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL., American College of Cardiology/American Heart Association Task Force. Pharmacists should counsel patients with renal disease to avoid magnesium-containing over the counter products. Nurses monitor patients, administer treatment, provide patient education, and report status changes to the rest of the team. The earlier signs and symptoms of a complication are identified, the better is the prognosis and outcome. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluation of all joint activities. Major complications associated with magnesium toxicity can be avoided if the interprofessional team can promptly diagnose and treat this disease.Ĭollaboration, shared decision-making, and communication are key elements for a positive outcome. The patient is to be stabilized as early as possible and subsequently monitored closely. If magnesium toxicity occurs, the role of prompt treatment cannot be undermined. Īn interprofessional team that provides a holistic and integrated approach to care can help achieve the best possible outcomes. However, as levels continue to rise, patients experience loss of deep tendon reflexes, sinoatrial (SA) or atrioventricular (AV) node blocks, respiratory paralysis, and, eventually, cardiac arrest. The most common findings of early-onset toxicity are diarrhea, nausea and vomiting, muscle weakness, and low blood pressure. When these processes are affected, whether it is due to under-excretion by the kidneys, over-absorbance by the small bowel, or displacement of stored magnesium into the serum, hypermagnesemia occurs and leads to magnesium toxicity. Magnesium is also involved in sodium, potassium, and calcium channels. The homeostasis of magnesium depends on kidney and small bowel function and storage in bone and cells. Approximately 60% of the total is stored in bone, 39% is stored intracellularly, and only 1% is found in its free or ionized active form in blood vessels. An average adult has approximately 22 to 26 grams of magnesium. Magnesium's importance is in protein synthesis, nerve and muscle functioning, bone growth, regulation of blood pressure and glucose, and normal cardiac rhythm. Magnesium serves as a co-factor for over 300 biochemical reactions within the body.
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