A patient in which of the following disorders is at high risk to develop hypermagnesemia?
A. Insulin shock
B. Hyperadrenalism
C. Nausea and vomiting
D. Renal failure
Correct Answer: D. Renal failure
Renal failure can reduce magnesium excretion, leading to hypermagnesemia. Hypermagnesemia refers to an excess amount of magnesium in the bloodstream. It is rare and is usually caused by renal failure or poor kidney function. Magnesium is a mineral the body uses as an electrolyte, meaning it carries electric charges around the body when dissolved in the blood.
Option A: Diabetic ketoacidosis, not insulin shock is a cause of hypermagnesemia. In DKA body magnesium deficits through urinary losses are routinely encountered and are the consequence of absence of insulin. However, magnesium exit from the cells may cause hypermagnesemia, which is frequent at presentation with DKA.
Option B: Hypoadrenalism, not hyperadrenalism is a cause of hypermagnesemia. Hypothyroidism and especially cortico-adrenal insufficiency, are other recognized causes. Hypomagnesemia is quite frequent, although the symptomatology (cramps, muscle spasms, paresthesia, and arrhythmias) appears only when exceeding the critical value.
Option C: Nausea and vomiting lead to hypomagnesemia. Very low magnesium levels typically result when an acute problem is superimposed on chronic depletion. For example, critical levels can occur among patients with diabetes during correction of ketoacidosis or alcoholics who develop vomiting, diarrhea, or pancreatitis.
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