{
  "name": "Magnesium Imbalances",
  "slug": "magnesium-imbalances",
  "url": "https://nursingplex.com/care-plans/magnesium-imbalances",
  "category": "Endocrine & Metabolic",
  "summary": "Hyper- and hypomagnesemia affecting reflexes, respirations and cardiac rhythm.",
  "nursing_diagnoses": [
    "Risk for electrolyte imbalance",
    "Decreased cardiac output",
    "Risk for injury"
  ],
  "overview": [
    "Magnesium is the second most abundant intracellular cation and a cofactor for hundreds of enzymes, including those governing potassium and calcium movement, neuromuscular transmission and cardiac conduction.",
    "Hypomagnesemia (below 1.5 mEq/L) usually results from alcohol use disorder, diarrhea, malabsorption, diuretics, proton pump inhibitors or poor intake, and produces hyperexcitability: tremor, hyperreflexia, positive Chvostek and Trousseau signs, torsades de pointes and seizures. It also causes refractory hypokalemia and hypocalcemia that will not correct until magnesium is replaced.",
    "Hypermagnesemia (above 2.5 mEq/L) is most often iatrogenic — magnesium therapy in preeclampsia, antacids or laxatives in renal failure — and produces depression: loss of deep tendon reflexes, respiratory depression, hypotension and cardiac arrest."
  ],
  "key_facts": [
    {
      "label": "Reflex rule",
      "text": "Hyperreflexia signals low magnesium; loss of the patellar reflex is the earliest warning of dangerous high magnesium."
    },
    {
      "label": "Antidote",
      "text": "IV calcium gluconate reverses severe hypermagnesemia."
    },
    {
      "label": "Refractory potassium",
      "text": "Hypokalemia that will not correct usually means unrecognized hypomagnesemia."
    },
    {
      "label": "Infusion safety",
      "text": "Give IV magnesium slowly by pump; rapid infusion causes hypotension and cardiac arrest."
    }
  ],
  "nursing_priorities": [
    "Identify the direction and cause of the imbalance.",
    "Monitor neuromuscular and cardiac status continuously in severe cases.",
    "Replace or remove magnesium safely.",
    "Correct associated potassium and calcium abnormalities.",
    "Prevent seizures, falls and respiratory compromise."
  ],
  "assessment": {
    "subjective": [
      "Reports of muscle twitching, cramps or tremor (low magnesium)",
      "Reports of weakness, drowsiness, flushing or nausea (high magnesium)",
      "History of alcohol use, diarrhea, diuretics or antacid and laxative use",
      "Reports of palpitations"
    ],
    "objective": [
      "Serum magnesium level with potassium and calcium",
      "Deep tendon reflexes: hyperactive when low, diminished or absent when high",
      "ECG: prolonged QT and torsades with low magnesium; bradycardia and widened QRS with high",
      "Respiratory rate and depth; hypotension in hypermagnesemia",
      "Positive Chvostek or Trousseau sign, tremor or seizure activity"
    ],
    "related_factors": [
      "Chronic alcohol use and malnutrition",
      "GI losses: diarrhea, fistula, malabsorption, prolonged suctioning",
      "Loop and thiazide diuretics, aminoglycosides, proton pump inhibitors",
      "Renal failure with magnesium-containing antacids or laxatives",
      "Magnesium sulfate therapy in obstetrics"
    ]
  },
  "goals": [
    "The client's serum magnesium will return to within normal limits.",
    "The client will maintain a stable cardiac rhythm.",
    "The client will retain intact deep tendon reflexes and respiratory effort.",
    "The client will remain free from seizures and injury."
  ],
  "interventions": [
    {
      "title": "Assess and monitor",
      "points": [
        "Check deep tendon reflexes and respiratory rate before and during magnesium therapy.",
        "Maintain continuous cardiac monitoring in moderate to severe imbalance.",
        "Follow magnesium, potassium, calcium and renal function levels.",
        "Monitor urine output, since magnesium is renally cleared."
      ]
    },
    {
      "title": "Treat hypomagnesemia",
      "points": [
        "Administer IV magnesium sulfate slowly via pump with cardiac monitoring.",
        "Replace potassium and calcium concurrently as ordered.",
        "Encourage magnesium-rich foods: green leafy vegetables, nuts, seeds, whole grains, legumes.",
        "Institute seizure precautions and a quiet environment."
      ]
    },
    {
      "title": "Treat hypermagnesemia",
      "points": [
        "Stop all magnesium-containing medications and infusions.",
        "Keep IV calcium gluconate available as the antidote and give as ordered.",
        "Support ventilation and prepare for dialysis in renal failure.",
        "Assess the patellar reflex, respirations and urine output hourly during magnesium sulfate therapy."
      ]
    }
  ],
  "patient_teaching": [
    "Advise patients with kidney disease to avoid magnesium-containing antacids and laxatives.",
    "Teach magnesium-rich food sources for those at risk of depletion.",
    "Explain why alcohol use and chronic diuretics deplete magnesium.",
    "Report muscle twitching, palpitations, severe drowsiness or weakness."
  ]
}