Fluid & Electrolyte Q 76

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Which clinical manifestation would lead the nurse to suspect that a client is experiencing hypermagnesemia?

  

    A. Muscle pain and acute rhabdomyolysis

    B. Hot flushed skin and diaphoresis

    C. Soft-tissue calcification and hyperreflexia

    D. Increased respiratory rate and depth

    

    

Correct Answer: B. Hot, flushed skin and diaphoresis

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Hypermagnesemia is manifested by hot, flushed skin and diaphoresis. The client also may exhibit hypotension, lethargy, drowsiness, and absent deep tendon reflexes. The most frequent symptoms and signs may include weakness, nausea, dizziness, and confusion (less than 7.0 mg/dL). Increasing values (7 to 12 mg/dL) induce decreased reflexes, worsening confusional state, drowsiness, bladder paralysis, flushing, headache, and constipation.

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Option A: Muscle pain and acute rhabdomyolysis are indicative of hypophosphatemia. Mild hypophosphatemia will not be clinically apparent. Severe hypophosphatemia may have the clinical presence of altered mental status, neurological instability including seizures and focal neurologic findings such as numbness or reflexive weakness, a cardiac manifestation of possible heart failure, muscle pain, and muscular weakness.

Option C: Soft-tissue calcification and hyperreflexia are indicative of hyperphosphatemia. Calcifications can also be present in skin, soft tissue, and periarticular regions. Prolonged bone demineralization can lead to bone fractures. CNS features include delirium, coma, seizures, neuromuscular hyperexcitability, (Chvostek’s sign and Trousseau’s phenomenon), hyperreflexia, muscle cramping (e.g., carpopedal spasm) or tetany.

Option D: Increased respiratory rate and depth are associated with metabolic acidosis. The physical exam reveals signs unique to each cause such as dry mucous membranes in the patient with diabetic ketoacidosis. Hyperventilation may also be present as a compensatory respiratory alkalosis to assist with PCO2 elimination and correction of the acidemia. Compensatory reactions do not completely correct a disturbance to the normal pH range.

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