Let's talk about hypomagnesemia. Let's break apart this very long word. Hypo means low, magnus is a shortened way of saying magnesium, and emia means in the blood.
So this long word means low levels of magnesium in the blood. A normal magnesium level is 1.5 to 2.5 milligrams per deciliter. An easy way to remember this is to think of a magnifying glass that you see 1.5 to 2.5 times bigger than normal. So hypomagnesemia is a magnesium level less than 1.5 milligrams per deciliter. Now let's look at the causes of hypomagnesemia.
What is causing this low level of magnesium in the blood? Magnesium is absorbed in the small intestine and it's excreted in the kidneys. This can help you remember some of the causes.
Chronic alcoholism is currently the most common cause of hypomagnesemia in the U.S. This is because alcohol stimulates the kidneys to waste magnesium. Loss of magnesium from the body, mostly the GI tract, can also cause hypomagnesemia.
This is things such as an NG tube suction, diarrhea, vomiting, fistulas, and diuretics. because these diurese the body. Malabsorption issues also cause hypomagnesemia. Things such as Crohn's disease, celiac disease, and malabsorption syndrome. Of course, limited intake of magnesium causes hypomagnesemia, like starvation and those who are on enteral and parenteral feedings.
This is because these feedings, these solutions, are magnesium deficient. meaning they don't have a lot of magnesium in their formulas, so the patient isn't getting any magnesium. Increased blood sugar levels also cause hypomagnesemia, like hyperglycemia and DKA. Now let's look at the signs and symptoms of hypomagnesemia.
But before we look at the signs and symptoms, it's important to know that magnesium acts like a sedative. This will help you remember the signs and symptoms. Since we have low levels of magnesium in hypomagnesemia, we're not gonna be sedated. So that means with hypomag we are going to have a lot of energy.
Again, what's the opposite of sedated? Having a lot of energy. We call this in the nursing field neuromuscular excitability because you are no longer sedated like in hypermag. You are excited and awake.
Your muscles are awake as well. So remember that when thinking of the signs and symptoms. Magnesium acts like a sedative, especially in the muscles.
And in hypomag we have a lot of energy. So all the signs and symptoms seen in hypomagnesemia think everything will be increased. So you're gonna have increased neuromuscular excitability.
Things such as tremors, muscle cramps, and weakness from being overworked. You're going to have rigid and tight muscles. You're also going to have increased DTRs, deep tendon reflex.
Everything will be increased, including increased brain activity. So we're going to see an irritable patient. They're going to have insomnia, confusion, and even seizures. Low levels of magnesium can cause seizures. Think about it.
everything is excited and awake, including the brain. Your heart is a muscle also, so the heart will be excited. Increased heart rate, increased blood pressure, and cardiac dysrhythmias because your heart is going crazy since it's so excited.
We're going to have increased GI motility, such as diarrhea. So think about it. Your airway consists of muscles, and remember, our muscles are excited and hypomag. So the muscles are not going to be relaxed. They're going to be tight and tense.
This is why we'll see stridor and laryngeal spasms. The esophagus is also a muscle and a tight intense esophagus can lead to swallowing problems. Now for nursing considerations.
What should you as a nurse do for this patient with hypomagnesemia? Mild deficiencies can be treated with simply increasing your intake of magnesium containing foods. Well let's look at some foods that are high in magnesium. Foods that are high in magnesium are avocados, green leafy vegetables like spinach, swiss chard, broccoli, and brussels sprouts. Almonds, figs, cashews, yogurt, and potatoes.
These are all foods that contain high amounts of magnesium. But more severe forms are treated with IV magnesium sulfate on an infusion pump. We want to give this infusion slowly. We don't want to give too much because it can lead to hypermagnesemia.
Remember how I said your airway is a muscle and it can become tight and tense? This can lead to swallowing problems. So we want to initiate aspiration precautions.
Since alcohol is the most common cause of hypomagnesemia, You as a nurse want to provide teaching, support, and possible referrals to an alcohol abstinence program. Remember that I said everything is excited and awake, including the brain, and this can cause seizures? So we want to place our patient on seizure precaution.
What does seizure precaution mean? You want to have oxygen and suction available to maintain a patent airway. You want to provide privacy as soon as possible. You want to have the side rails up. and padded to ensure safety.
You want to have the client in side lying position immediately post seizure. This is to prevent aspiration if they've had any secretions during the seizure. You want to place the client laying down with a pillow under the head to protect their head.
You want to loosen any restrictive clothing they may have on them. You want the bed in lowest position to ensure safety. Just in case they were to fall off the bed, it would be in the lowest position.
You want to note the time and duration of the seizure. This is because if the seizure lasts more than five minutes, it's called status epilepticus, and this needs immediate attention. There are some things you should never do while a patient is having a seizure. You don't want to restrain the client because this can lead to even more injury.
You never want to force the jaw open or place anything in the client's mouth. You never want to leave the client. This is a huge NCLEX tip so listen. The question will try to trick you. To make it sound like leaving a client to get help is the only possible answer.
But remember you never leave a client having a seizure. Pick a different answer. Don't leave the client having a seizure.
Now let's look at the relationship between magnesium and another electrolyte, calcium. Magnesium works closely with calcium. They're like best buds. So when one rises, the other one rises. And when one falls, the other one falls.
That's all for hypomagnesemia. To grab your magnesium imbalance study guide, the link is in the description below.