Limits...
Magnesium Toxicity-Induced Ileus in a Postpartum Patient Treated for Preeclampsia With Magnesium Sulphate.

Al-Shoha M, Klair JS, Girotra M, Garcia-Saenz-de-Sicilia M - ACG Case Rep J (2015)

Bottom Line: Hypermagnesemia is a rare and under-recognized cause of paralytic ileus.Detailed history was employed to consider hypermagnesemia-induced ileus as the working diagnosis, and the patient improved with correction of the electrolyte imbalance.Hypermagnesemia-induced lethargy, decreased reflexes, muscle weakness, flaccid paralysis, respiratory muscle paralysis, and cardiac arrest are well-described; however, intestinal smooth muscle dysfunction leading to paralytic ileus has never been reported in the setting of magnesium use for peripartum preeclampsia management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

ABSTRACT
Hypermagnesemia is a rare and under-recognized cause of paralytic ileus. We report a case of a 21-year-old primigravida who was managed aggressively for preeclampsia and presented with postpartum paralytic ileus. Detailed history was employed to consider hypermagnesemia-induced ileus as the working diagnosis, and the patient improved with correction of the electrolyte imbalance. Hypermagnesemia-induced lethargy, decreased reflexes, muscle weakness, flaccid paralysis, respiratory muscle paralysis, and cardiac arrest are well-described; however, intestinal smooth muscle dysfunction leading to paralytic ileus has never been reported in the setting of magnesium use for peripartum preeclampsia management.

No MeSH data available.


Related in: MedlinePlus

Abdominal x-ray showing multiple air-fluid levels concerning for small bowel obstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4508949&req=5

Figure 1: Abdominal x-ray showing multiple air-fluid levels concerning for small bowel obstruction.

Mentions: A 21-year-old primigravida was admitted at week 37 of gestation to an outside hospital with lethargy, decreased urine output, and hypertension. She was managed aggressively for preeclampsia, underwent emergent Cesarean section for non-reassuring fetal heart tracing (NRFHT), and was later transferred to high-risk obstetric unit for continued low urine output (650 cc over 24 hours). She was ill-appearing with distended abdomen, hypoactive bowel sounds, diffuse mild tenderness with no rebound tenderness or guarding, lethargy, vision changes, and decreased reflexes. The laboratory work-up showed normal complete blood count, mild renal injury with creatinine 1.6 mg/dL, potassium 5.6 mEq/L, normal hepatic function, magnesium levels 7.1 mg/dL (down from maximum of 9 mg/dL), calcium 6.8 mg/dL, and ionized calcium 1.17 mmol/L. Abdominal x-ray showed multiple air-fluid levels concerning for small bowel obstruction (SBO; Figure 1), confirmed with abdominal computed tomography (CT) that showed partial SBO with transition point in the right lower quadrant and collapsed distal ileum (Figure 2).


Magnesium Toxicity-Induced Ileus in a Postpartum Patient Treated for Preeclampsia With Magnesium Sulphate.

Al-Shoha M, Klair JS, Girotra M, Garcia-Saenz-de-Sicilia M - ACG Case Rep J (2015)

Abdominal x-ray showing multiple air-fluid levels concerning for small bowel obstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508949&req=5

Figure 1: Abdominal x-ray showing multiple air-fluid levels concerning for small bowel obstruction.
Mentions: A 21-year-old primigravida was admitted at week 37 of gestation to an outside hospital with lethargy, decreased urine output, and hypertension. She was managed aggressively for preeclampsia, underwent emergent Cesarean section for non-reassuring fetal heart tracing (NRFHT), and was later transferred to high-risk obstetric unit for continued low urine output (650 cc over 24 hours). She was ill-appearing with distended abdomen, hypoactive bowel sounds, diffuse mild tenderness with no rebound tenderness or guarding, lethargy, vision changes, and decreased reflexes. The laboratory work-up showed normal complete blood count, mild renal injury with creatinine 1.6 mg/dL, potassium 5.6 mEq/L, normal hepatic function, magnesium levels 7.1 mg/dL (down from maximum of 9 mg/dL), calcium 6.8 mg/dL, and ionized calcium 1.17 mmol/L. Abdominal x-ray showed multiple air-fluid levels concerning for small bowel obstruction (SBO; Figure 1), confirmed with abdominal computed tomography (CT) that showed partial SBO with transition point in the right lower quadrant and collapsed distal ileum (Figure 2).

Bottom Line: Hypermagnesemia is a rare and under-recognized cause of paralytic ileus.Detailed history was employed to consider hypermagnesemia-induced ileus as the working diagnosis, and the patient improved with correction of the electrolyte imbalance.Hypermagnesemia-induced lethargy, decreased reflexes, muscle weakness, flaccid paralysis, respiratory muscle paralysis, and cardiac arrest are well-described; however, intestinal smooth muscle dysfunction leading to paralytic ileus has never been reported in the setting of magnesium use for peripartum preeclampsia management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

ABSTRACT
Hypermagnesemia is a rare and under-recognized cause of paralytic ileus. We report a case of a 21-year-old primigravida who was managed aggressively for preeclampsia and presented with postpartum paralytic ileus. Detailed history was employed to consider hypermagnesemia-induced ileus as the working diagnosis, and the patient improved with correction of the electrolyte imbalance. Hypermagnesemia-induced lethargy, decreased reflexes, muscle weakness, flaccid paralysis, respiratory muscle paralysis, and cardiac arrest are well-described; however, intestinal smooth muscle dysfunction leading to paralytic ileus has never been reported in the setting of magnesium use for peripartum preeclampsia management.

No MeSH data available.


Related in: MedlinePlus