Reactions 950 - 10 May 2003

SAntacid

Acute hypermagnesaemia following bone marrowtransplantation: case report

A 16-year-old girl who had undergone bone marrowtransplantation for acute lymphoblastic leukaemia developedacute hypermagnesaemia after taking an antacid containingmagnesium for epigastric pain. She had also receivedcyclosporin for the prevention of graft-versus-host disease.

The girl became unresponsive, unarousable anddemonstrated loss of deep tendon reflex 3 days after startingtreatment with an aluminium magnesia oral suspension (Al Mggel) [1mL containing Mg(OH)2 paste 30% 133mg]. She hadbeen advised to take 15mL of the suspension every 4 hours,but had taken the agent every 2 hours. She had undergonebone marrow transplantation 47 days before starting theantacid.

On examination, she was hypothermic, hypotensive and herpupils were unreactive to light and accomodation. In addition,a Babinski reflex could not be detected and her extremitieswere flaccid with hypotonia. Tests revealed a serummagnesium concentration of 5.6 mmol/L (normal 0.53–1.07);this concentration subsequently peaked at 5.9 mmol/L. Inaddition, her creatinine level was elevated, she had adecreased serum sodium level and urinalysis revealed a largeamount of haemoglobin.

The aluminium magnesia oral suspension was discontinuedand the girl received dopamine, non-alkaline IV fluids andfurosemide. Her magnesium concentration subsequentlydecreased and was 2.6 mmol/L 72 hours after startingsupportive treatment. Her neurological status graduallyimproved and her serum magnesium concentration hadreturned to normal 12 days after her initial presentation.

Author comment: "In this patient, hypermagnesemia maybe caused by excess use of antacid for relief of gastrointestinaldistress or renal failure induced by the use of cyclosporine,nephrotoxic antibiotics, and chemoirradiation conditioning inthe management of BMT [bone marrow transplantation]. Thedeleterious consequences of BMT may predispose to antacid-induced hypermagnesemia."Jaing TH, et al. Acute hypermagnesemia: a rare complication of antacidadministration after bone marrow transplantation. Clinica Chimica Acta 326:201-203, Dec 2002 - Taiwan 807212436

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Reactions 10 May 2003 No. 9500114-9954/10/0950-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved