酸化マグネシウム長期内服による重症高マグネシウム血症の3例  [in Japanese] Severe hypermagnesemia caused by the long-term administration of magnesium oxide : three case reports  [in Japanese]

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Abstract

高マグネシウム(Mg)血症は,その多くが医原性とされ,Mg製剤投与で起こる比較的稀な病態である。我々は,便秘症に対して処方された酸化マグネシウム(MgO)の長期内服により,重症高Mg血症を来した3例を経験したので報告する。3例とも当院来院時には血清Mg濃度が15mg/dlを超えており,血圧低下や意識障害を来していた。全例グルコン酸カルシウムを投与するとともに,1例は持続的血液透析(continuous hemodialysis; CHD)を,1例は血液透析(hemodialysis; HD)を施行して治療したが,最終的に1例は救命できなかった。従来,MgOのように1回投与当りのMg含有量が少ないMg製剤による重症高Mg血症のリスクは高くないとされてきたが,本症例のような長期投与は,重症高Mg血症の危険因子となり得るため注意が必要である。また高Mg血症の症状は非特異的であるため,積極的に疑わなければ早期診断が困難であり,しかも診断と治療が遅れれば致死的となり得る。このため,便秘症に対してMg製剤を長期間処方する際には,高Mg血症発症の可能性を想定し,必要に応じて血清Mg濃度の測定を施行することも含めた経過観察を行うべきである。

Hypermagnesemia is a rare and often iatrogenic condition caused by the administration of magnesium-containing medications. We report 3 cases of severe hypermagnesemia caused by the long-term administration of magnesium oxide for constipation. The serum magnesium levels of the patients exceeded 15 mg/dl and caused shock and coma. Although the patients were treated with intravenous calcium and conventional or continuous hemodialysis, one of them died. Studies have reported that severe hypermagnesemia caused by the administration of magnesium oxide is less common than that caused by the administration of a single dose of any other magnesium-containing medications, such as magnesium citrate or magnesium sulfate, that contain a larger magnesium load. However, the findings in the present cases suggest that long-term administration of magnesium-containing medications with a lower magnesium load can also be a risk factor for severe hypermagnesemia. Hypermagnesemia is difficult to diagnose because of nonspecific symptoms. In addition, it can be fatal if initial diagnosis and treatment have been delayed. Therefore, close observation with serum magnesium measurements according to need should be performed when magnesium-containing cathartics are prescribed to a patient for a long time.

Journal

  • Nihon Kyukyu Igakukai Zasshi

    Nihon Kyukyu Igakukai Zasshi 21(7), 365-371, 2010-07-15

    Japanese Association for Acute Medicine

References:  14

Codes

  • NII Article ID (NAID)
    10030254645
  • NII NACSIS-CAT ID (NCID)
    AN10284604
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    0915924X
  • Data Source
    CJP  J-STAGE 
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