The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:
A. MOM can cause magnesium toxicity.
B. MOM is too harsh on the bowel.
C. Metamucil is more palatable.
D. MOM is high in sodium.
Correct Answer: A. MOM can cause magnesium toxicity.
Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. The kidney has a vital role in magnesium homeostasis and, although the renal handling of magnesium is highly adaptable, this ability deteriorates when renal function declines significantly. In moderate chronic kidney disease (CKD), increases in the fractional excretion of magnesium largely compensate for the loss of glomerular filtration rate to maintain normal serum magnesium levels.
Option B: MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem. As such, renal failure patients might be more vulnerable to changes in magnesium intake via the diet or via medication (e.g. antacids or phosphate binders) and/or the use of diuretics. Furthermore, intestinal absorption of magnesium can also be influenced by calcium and vice versa
Option C: A client may find both MOM and Metamucil unpalatable. People of all ages should drink a full glass, or 8 ounces, of water with each dose of milk of magnesia. If anyone experienced diarrhea after taking a dose of milk of magnesia, they should avoid taking it again.
Option D: MOM is not high in sodium. Milk of magnesia is a type of hyperosmotic laxative. This kind of oral laxative works by drawing water to the bowel from nearby tissue. This softens and moistens the stool. It also helps increase bowel activity.
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