Skip to main content

Hypermagnesemia-induced paralytic ileus

Summary

Hypermagnesemia is a well-known cause of hypotension and cardiac dysfunction but not well recognized is the induction of paralytic ileus. This report details the second and third adult patients reported with hypermagnesemia-induced paralytic ileus. The first patient was a 65-year-old white woman with normal renal function, who had consumed large amounts of magnesium citrate and milk of magnesia. As magnesium blood level fell from 5.1 mg/dl on admission to 2.4 mg/dl on day 3, the vomiting, obstipation, and abdominal distension resolved. The second patient was a 67-year-old woman with mild renal insufficiency, who consumed a large amount of Epsom salts containing magnesium sulfate to treat her constipation. Magnesium levels of 8.1 mg/dl on admission fell to below 3.1 mg/dl on the third hospital day and the paralytic ileus resolved. Mechanical obstruction was ruled out by colonoscopy, gastrographin enema, and barium small bowel series in both patients. Although the clinical findings of muscle weakness, flaccid paralysis, respiratory muscle paralysis or cardiac arrest due to hypermagnesemia are well described in the literature, intestinal smooth muscle dysfunction leading to paralytic ileus has only been reported in one other adult patient. The laboratory and clinical course of these two patients strongly suggest a causal relationship between hypermagnesemia and paralytic ileus.

This is a preview of subscription content, access via your institution.

References

  1. Hill W, Gill P, Katz M: Maternal paralytic ileus as a complication of magnesium sulfate tocolysis. Am J Perinatol 2:47–48, 1985

    PubMed  Google Scholar 

  2. Beleslin D, Samardizic R: Pharmacological analysis of the peristalsis block induced by magnesium applied at the serosal and mucosal surfaces of the isolated guinea-pig ileum. CR Soc Biol Paris 171:750–754, 1977

    Google Scholar 

  3. Iseri L, French J: Magnesium: Nature's physiologic calcium blocker. Am Heart J 108:188–189, 1984

    PubMed  Google Scholar 

  4. Van Hook J: Hypermagnesemia. Crit Care Clin 7:215–223, 1991

    PubMed  Google Scholar 

  5. Mordes J, Swartz R, Arky R: Extreme hypermagnesemia as a cause of hypotension. Ann Intern Med 83:657–658, 1975

    PubMed  Google Scholar 

  6. Sokal M, Koenigsberger M, Rose J: Neonatal hypermagnesemia and the meconium plug syndrome. N Engl J Med 286:823–826, 1972

    PubMed  Google Scholar 

  7. Mangel A, Conner J, Prosser C: Effects of alterations in calcium level on cat small intestinal slow waves. Am J Physiol 243:C7-C13, 1982

    PubMed  Google Scholar 

  8. Cooney D, Rosevear W, Grosfield J: Maternal and postnatal hypermagnesemia and the meconium plug syndrome. J Pediatr Surg 11:167–172, 1976

    PubMed  Google Scholar 

  9. Miller T, Duke J: Fluid and electrolyte management.In Manual of Preoperative and Postoperative Care. Philadelphia, PA, WB Saunders Company, Editorial Committee on Pre- and Postoperative Care, 1983, pp 38–67

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Golzarian, J., William Scott, H. & Richards, W.O. Hypermagnesemia-induced paralytic ileus. Digest Dis Sci 39, 1138–1142 (1994). https://doi.org/10.1007/BF02087570

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02087570

Key words

  • magnesium
  • paralytic ileus
  • acute colonic pseudoobstruction