Furosemide/magnesium sulfate

Furosemide/magnesium sulfate Reactions 1680, p147 - 2 Dec 2017 Various toxicities: case report A 21-year-old pregnant woman developed hypocalcaemia and hyperkalaemia secondary to hypermagnesaemia during treatment with magnesium sulfate for seizure prophylaxis. Additionally, she also developed hypokalaemia following treatment with furosemide for volume overload and hypertension [not all routes and dosages stated]. The woman was hospitalised in the ICU for the management of severe preeclampsia during the week 17 of the gestation. Additionally, severe hypertension and mild hyperkalaemia was also reported. She subsequently received two doses of IV furosemide 10mg on hospital day 1 and 2 doses of IV furosemide 20mg on day 2, for volume overload and hypertension. Two doses of IV furosemide 20mg were repeated on day 3 and day 4. She also received IV magnesium sulfate infusion mixed with ringer’s lactate at a rate of 25 mL/h for seizure prophylaxis. The magnesium sulfate infusion was continued for the first 3 days of her hospitalisation with close neurological and electrolytes monitoring. She also received treatment with oral magnesium sulfate. Thereafter, she underwent an urgent elective caesarean delivery of the foetus due to severe preeclampsia and as the foetal ultrasound findings incompatible with the life. After the delivery, she developed significant changes in the serum calcium and potassium levels, corresponding to high serum magnesium levels. Her serum magnesium level, which was 2.6 mg/dL on day 1 of admission, increased to 7.9 mg/dL on day 3. Her serum calcium level initially decreased to 6.1 mg/dL on day 3 of the hospitalisation which later increased to 7.6 mg/dL on day 9 while her serum potassium level increased to 5.5 [unit not stated] on admission day 3 from 4.8 on day 1. Work up for aetiology of hyperkalaemia included plasma aldosterone concentration of 19.2 ng/dL, plasma renin activity of 9.6 ng/mL/h and a trans-tubular potassium gradient of 4.6. After excluding other causes of hyperkalaemia, a diagnosis of hypermagnesaemia-induced hyperkalaemia was made. Furthermore, her hypocalcaemia was attributed to magnesium sulfate infusion. Her serum potassium level started to decline after the discontinuation of magnesium sulfate infusion on admission day 3. The woman was also noted to have slight hypokalaemia after normalisation of serum magnesium levels, which was attributed to administration of IV furosemide. Eventually, her calcium level started to decline, corresponding to increasing magnesium levels. Her serum calcium normalised after normalisation of the serum magnesium levels to 1.6 mg/dL on day 9. Her potassium level subsequently normalised to 3.9 on day 9. Author comment: "We report the development of hypocalcaemia and hyperkalaemia attributable to magnesium infusion in a preeclamptic patient. Iatrogenic hypermagnesaemia should be considered in the differential diagnoses of hypocalcemia and hyperkalemia whenever magnesium infusions are used, especially for obstetric indications." "After excluding other causes of hyperkalaemia, a diagnosis of hypermagnesaemia-induced hyperkalaemia was made." Hudali T, et al. Hypocalcemia and hyperkalemia during magnesium infusion therapy in a pre-eclamptic patient. Clinical Case Reports 3: 827-831, No. 10, Oct 2015. Available from: URL: http://doi.org/10.1002/ccr3.356 - USA 803284686 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Furosemide/magnesium sulfate

Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Publisher
Springer International Publishing
Copyright
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-017-39078-4
Publisher site
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Abstract

Reactions 1680, p147 - 2 Dec 2017 Various toxicities: case report A 21-year-old pregnant woman developed hypocalcaemia and hyperkalaemia secondary to hypermagnesaemia during treatment with magnesium sulfate for seizure prophylaxis. Additionally, she also developed hypokalaemia following treatment with furosemide for volume overload and hypertension [not all routes and dosages stated]. The woman was hospitalised in the ICU for the management of severe preeclampsia during the week 17 of the gestation. Additionally, severe hypertension and mild hyperkalaemia was also reported. She subsequently received two doses of IV furosemide 10mg on hospital day 1 and 2 doses of IV furosemide 20mg on day 2, for volume overload and hypertension. Two doses of IV furosemide 20mg were repeated on day 3 and day 4. She also received IV magnesium sulfate infusion mixed with ringer’s lactate at a rate of 25 mL/h for seizure prophylaxis. The magnesium sulfate infusion was continued for the first 3 days of her hospitalisation with close neurological and electrolytes monitoring. She also received treatment with oral magnesium sulfate. Thereafter, she underwent an urgent elective caesarean delivery of the foetus due to severe preeclampsia and as the foetal ultrasound findings incompatible with the life. After the delivery, she developed significant changes in the serum calcium and potassium levels, corresponding to high serum magnesium levels. Her serum magnesium level, which was 2.6 mg/dL on day 1 of admission, increased to 7.9 mg/dL on day 3. Her serum calcium level initially decreased to 6.1 mg/dL on day 3 of the hospitalisation which later increased to 7.6 mg/dL on day 9 while her serum potassium level increased to 5.5 [unit not stated] on admission day 3 from 4.8 on day 1. Work up for aetiology of hyperkalaemia included plasma aldosterone concentration of 19.2 ng/dL, plasma renin activity of 9.6 ng/mL/h and a trans-tubular potassium gradient of 4.6. After excluding other causes of hyperkalaemia, a diagnosis of hypermagnesaemia-induced hyperkalaemia was made. Furthermore, her hypocalcaemia was attributed to magnesium sulfate infusion. Her serum potassium level started to decline after the discontinuation of magnesium sulfate infusion on admission day 3. The woman was also noted to have slight hypokalaemia after normalisation of serum magnesium levels, which was attributed to administration of IV furosemide. Eventually, her calcium level started to decline, corresponding to increasing magnesium levels. Her serum calcium normalised after normalisation of the serum magnesium levels to 1.6 mg/dL on day 9. Her potassium level subsequently normalised to 3.9 on day 9. Author comment: "We report the development of hypocalcaemia and hyperkalaemia attributable to magnesium infusion in a preeclamptic patient. Iatrogenic hypermagnesaemia should be considered in the differential diagnoses of hypocalcemia and hyperkalemia whenever magnesium infusions are used, especially for obstetric indications." "After excluding other causes of hyperkalaemia, a diagnosis of hypermagnesaemia-induced hyperkalaemia was made." Hudali T, et al. Hypocalcemia and hyperkalemia during magnesium infusion therapy in a pre-eclamptic patient. Clinical Case Reports 3: 827-831, No. 10, Oct 2015. Available from: URL: http://doi.org/10.1002/ccr3.356 - USA 803284686 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680

Journal

Reactions WeeklySpringer Journals

Published: Dec 2, 2017

References

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