hey everyone it's Sarah with register nurse ran.com and in this video I'm going to be going over hypomagnesemia in my previous video I covered hyper magnesia so in this video we're going to go over hypo and I'm going to cover the causes the signs and symptoms and the nursing interventions and give you some clever pneumonics on how to remember that material also I'm going to hit the key concepts of things that are hit on on the incl exam and on your nursing lecture exams now after this video be sure to go to my website register nurse ran.com and take the free quiz that will test your knowledge on the difference between hyper and hypo magnesia a card should be popping up or a link should be in the description below so let's get started okay as always I like to break these words down and determine what electrolyte we are dealing with and is it high or low okay first part of this word is hypo hypo means under magnes is the prefix for magnesium so we already know we are dealing with the electrolyte magnesium and emia the other part of the word means blood so you put all that together and what do you get you get low magnesium in the blood now what is a normal magnesium level a normal mag level is 1.6 to 2.6 mg per deciliter and anything less than 1.6 is considered hypomagnesemia now let's go over the role of Mag in the body whenever you understand how the function of Mag works in your body you will understand why things cause low magnesium and the signs and symptoms of what you're seeing they all go hand in hand so I really wanted to include this okay magnesium plays a huge function in your cells it helps transfer energy and store energy and regulates the parathyroid hormone which plays a very important role in calcium levels and we talked about this back in the calcium electrolyte videos hypocalcemia and hypocalcemia and we talked about the parathyroid now a lot of times whenever you have low mag levels you're going to have low calcium levels as well and this is because um the parathyroid is affected by magnesium and it releases the release of mag is inhibited whenever you start getting parathyroid issues and that's why you're going to see the low calcium levels next um mag helps in metabolizing your carbs your lipids and your proteins and it regulates blood pressure so that's another thing whenever you start seeing hypertension in hypomagnesemia or hypotension and Hyer magnesia is because magnesium plays a huge role on your blood pressure regulation also another important thing is where magnesium is absorbed it is absorbed in the small intestine so anything that's wrong with your GI system that's affecting absorption is going to affect how much magnesium you take into your body which can limit your magnesium levels which causes hypomagnesemia and it's excreted by your kidneys so if your kidneys are messed up or if they're wasting too much magnesium or keeping too much magnesium that can throw those mag levels off off okay so let's look at the causes of hypomagnesemia now to help you remember this I have tried to break it down and created this pneumonic so remember the phrase low mag we're already dealing with low mag so this will help you remember and each letter will correlate with the cause Okay so first let's start with l l stands for limited intake of magnesium you see this in Starvation people who aren't being able to eat they have really low mag levels cuz foods are rich in and you don't get it you have low mag levels oh other electrolyte issues cause low mag and remember this hypocalcemia causes it and hypoc Calia causes it and remember the O and the hypo because whenever you have low mag levels you will also have those low levels next W wasting mag in the kidneys remember kidneys are huge for getting rid of our mag level so if that patient remember this for a test a lot of tests like to throw out these drugs if a patient is on any type of loop or th thide diuretics they are at risk for low mag levels or cyclosporins because this stimulates the kidneys to waste mag next in for malabsorption issues this gets back to magnesium's role in absorption in the small intestine so if a patient has a history of Crohn celiacs they've invol vomiting that can throw off your mag levels they won't take that absorb it in their stomach also drugs like proton pump inhibitors like protonics give a lot of that in the hospital PR prisc Nexium as well any of those GI drugs that end in um p r a z o l e watch out for those because those affect the way that the body is absorbing um magnesium a this is another huge one that's why I have an astri by alcohol um alcohol patients who have a history of alcoholism actively use a lot of alcohol they um are at risk because they have usually poor dietary habits and alcohol actually stimulates the kidneys to waste magnesium and a lot of times alcoholics they have acute pancreatitis which affects your mag levels and this right here um I remember test questions from nursing school on this they'll give you a scenario about a patient um talks about their alcohol consumption and they'll say which electrolyte do you expect to be affected by this or something like that so just remember that magnesium and people who use alcohol or who are alcoholics they have issues with magnesium levels and we'll get into that here in a second um a little bit more of a test question that they'll ask you in the signs and symptoms okay and then lastly G glycemic issues patients who are going in diabetic keto acidosis dka or insulin Administration this can also throw off your mag levels as well okay so let's look at the signs and symptoms of hypomagnesemia how do these patients look and present remember the phrase twitching with low mag levels you have neuromuscular excitability everything is twitching and it's really excited your reflex reflexes are very high reflexive but it it's the opposite in high magnesium everything is lethargic and weak you don't even have deep tendon reflexes they'll be extremely diminished or completely absent so remember that it's the complete opposite of hyper okay T for the first part of twitching positive true so sign remember in the calcium videos I discussed this in depth um with the hypomagnesemia you will have that and that's to do because the patient has low calcium levels W for weak respirations I for irritable they'll be irritable they won't be happy at all te for Tad's de poest this is very important I put a Aster by this this goes along with the alcoholism which I'll get into here in a second this right here is an abnormal heart rhythm it's lethal patient goes into it they're going to go in cardiac AR and you start CPR everything and this is seen in patients who have alcohol abuse and this is a classic scenario it'll say a patient comes in their alcohol levels this all of a sudden they go into SIDS what will you check as a nurse and you will check a magnesium level anytime these patients are going in to this Rhythm you want to look at mag level because this is normally what is causing that and tetany this is the abnormal twitching Okay C for cardiac changes another thing you need to remember exams love to hit on this um whenever you have low mag levels if it's moderately low you will see tall t- waves and depressed St segments remember that very important and if it's severe you can have prolong PR and QT intervals with wide QRS complexes and whenever you start seeing those QT intervals that are widened this is putting the patient majorly at rist back to torsade so you definitely need to watch out for that and you can also the and soad the two ways when and Tall they'll go to Flat okay and then the other C part of that um they'll have a positive CH chotski sign which goes back again to the hypocalcemia okay H for hypertension and hyperlexia this again remember mag regulates your blood pressure So the patient's going to have high blood pressure I for involuntary movements n for nausea and G for GI issues they'll have decreased bows and mo mobility of the bowels okay to nursing interventions this is a big section that tests love to ask you what are you going to do as a nurse for this patient with a low mag level okay first thing you want to monitor their cardiac their GI respiratory neurostatus very important and put them on a cardiac Monitor and monitor for any EKG changes that we talked about earlier next the doctor May order some potassium oral supplements and again this is due to the low um potassium levels and it's hard to actually get magnesium levels up if the calcium levels are low so you want to do a balancing act and get them both up together next the doctor May order some calcium supplements with vitamin D or 10% calcium gluconate if the calcium levels are low to help with that and this one is a big one for sure if the levels are really low the doctor will order magnesium sulfate IV infusion and with this you have to monitor the magnesium levels very closely because you can send them into hyper magnesia and as the nurse what you need to be doing while you're giving this infusion is checking deep tendon reflexes because remember in hypomagnesemia the reflexes are Super Active but in hyper magnesia you will have diminished or absent deep tendon reflexes so if the patient starts having that you've probably increase their magnesium level way too much um place in seizure precautions because they're at risk for this and if the doctor does order oral magnesium watch because this can give the patient diarrhea and diarrhea will waste magnesium and you you could even drop their levels even more so watch for that and another thing of course exams love to ask what foods are you going to feed the patient with this type of magnesium level so make sure you know foods that are rich in mag and I've thought of this little phrase to help you remember each letter correlates with the food uh remember the phrase always get plenty of foods containing large numbers of magnesium so a for avocado g for green leafy vegetables this can be spinach kale anything like that P for peanut butter and pork o for oatmeal fish uh specifically like canant tuna mackerel uh C for cauliflower and chocolate specifically dark chocolate L for legumes uh n for nuts o for oranges and M for milk and those are our foods that you want to encourage these people who have low mag levels to consume okay so that is a little bit about hypomagnesemia thank you so much for watching and don't forget to take the free quiz I will test your knowledge on the difference between hyper and hypo magnesia and thank you so much for watching and please consider subscribing to this YouTube channel