Magnesium (1.5-2.5 mEq/L) General facts 50-60% in bone Catalyst for many enzyme functions; especially CHO, protein, Na-K pump Neuromuscular activity affected r/t transmission of neural impulses Factors regulate Ca++ -play role in regulating Mg and vitamin D Kidneys – excrete; diuretics on Henle’s loop increase Mg excretion Bound to protein & ionized – ionized only has neuromuscular effect Deficit – increase muscular irritability Excess – sedative effect ETOH – deficit secondary to decreased diet intakeHypomagnesium < 1.5 mEq/L Etiology - Decreased absorption GI; increased excretion urine; mannitol/urea/glucose; renal disease; pancreatitis; diabetes (osmotic diuresis due to hyperglycemia) Lab tests- Serum Mg, Serum albumin, Serum K+, Serum Ca++, ECG Therapeutic Management Increased diet intake of Mg Mg++ antacids Severe – give Mg sulfate IV; give slowly, monitor carefully Nursing Care Assess S/S - vertigo, hallucinate, laryngeal stridor, hypotension, tachycardia, hypotension, sensitive to digoxin, Trousseau’s/Chvostek’s signs, paresthesias, N/V, anorexia Nursing Diagnosis - Risk for injury r/t, Risk for altered cardiac function r/t, Altered nutrition less than requirements r/t; Knowledge deficit Nursing actions Monitor serum levels Oral Mg Diet – foods high in Mg (green vegetables, nuts, peanut butter, chocolate, grapefruit, orange juice IV – MgSO4 if severe Ca gluconate – for tetany Monitor respiratory status, V/S, HR, ECG Teach use of diuretics, laxatives, diet Client education Explanation of condition; include risk factors Strategies to prevent further episodes Foods high in Mg Medication therapy including possible side effects S/S and what and when to reportHypermagnesemia > 2.5 mEq/L– decreased excitability of muscles; vasodilation Etiology – Mg antacids, renal failure, DM ketoacidosis Lab tests - Serum Mg+, ECG Therapeutic management Prevent! D/C foods, meds high in Mg Adequate renal function – give 1/2 NS & diuretics to excrete excess IV Ca gluconate Respiratory support Hemodialysis Nursing Care Assess S/S - hypotension, irregular HR, lethargy, drowsy, confusion, muscle weakness, coma, decreased DTR's Nursing diagnosis - Risk for injury r/t; Risk for altered cardiac function r/t; risk for altered respiratory status; Knowledge deficit r/t Nursing actions Assess neuromuscular, V/S, S/S Monitor serum Mg+ levels; ECG Safety measures Teach: foods/medications high in Mg Client education Explanation of condition; include risk factors Strategies to prevent further episodes Foods high in Mg Medication therapy including possible side effects S/S and what and when to report
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