高マグネシウム血症により意識障害をきたした慢性腎不全の２例

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  • Consciousness disturbance due to hypermagnesemia in two patients with chronic renal failure

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Consciousness disturbances in untreated end stage renal failure are referred to as uremic encephalopathy, which is now rare in Japan as dialysis therapy is readily available. We describe two chronic renal failure (CRF) patients who developed consciousness disturbances attributable to hypermagnesemia.<br>Case 1. A 77-year-old man with CRF due to diabetic nephropathy was transferred to our hospital because of appetite loss and drowsiness. Serum creatinine and blood urea nitrogen (BUN) levels were 4.31 and 64mg/dL, respectively. The serum magnesium (Mg) level was found to be as high as 7.3mg/dL. The calcium level was 5.8mg/dL. He had cutaneous flushing and respiratory insufficiency caused by respiratory depression in addition to pneumonia. The serum Mg level decreased after hemodialysis with improvement of consciousness disturbances. However, the serum Mg level rose again on the next day, and an additional hemodialysis session was needed.<br>Case 2. A 78-year-old woman with rheumatoid arthritis developed urinary tract infection which induced acute deterioration of CRF. She demonstrated general fatigue and disorientation. The serum Mg, creatinine and BUN levels were 7.1, 6.56 and 96mg/dL, respectively. Her consciousness level was normalized as the Mg levels decreased after three successive days of hemodialysis.<br>Both of these patients demonstrated rather mild azotemia and developed consciousness disturbances during the use of magnesium oxide. Of our 78 patients starting hemodialysis in the past two years, only these two patients demonstrated toxic serum Mg levels. We suggest that the use of Mg can cause symptomatic hypermagnesemia in patients with acute deterioration of CRF, and that hypocalcemia may worsen the manifestations of hypermagnesemia.<br>Conclusions: As Mg toxicity is a serious and potentially fatal condition, early and accurate diagnosis must be made especially in CRF patients with consciousness disturbances. Hemodialysis is effective for the treatment, but postdialysis rebound of the serum Mg level must be carefully observed.

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