A nurse is assessing a client who has hypermagnesemia. Which of the following medications should the nurse prepare to administer?
A.
Calcium gluconate
B.
Flumazenil
C.
Protamine sulfate
D.
Acetylcysteine
The Correct Answer and Explanation is:
The correct answer is A. Calcium gluconate.
Explanation
Hypermagnesemia, an elevated level of magnesium in the blood, can result from excessive intake of magnesium-containing medications (e.g., antacids, laxatives) or be a consequence of renal dysfunction where the kidneys are unable to excrete magnesium efficiently. The condition can lead to several clinical manifestations including neuromuscular and cardiovascular disturbances.
Symptoms of Hypermagnesemia:
- Neuromuscular Effects: Symptoms such as muscle weakness, decreased deep tendon reflexes, and lethargy.
- Cardiovascular Effects: Bradycardia, hypotension, and potentially, cardiac arrest.
- Respiratory Effects: Respiratory depression due to neuromuscular impairment.
Treatment for Hypermagnesemia:
The primary treatment for severe hypermagnesemia involves counteracting the effects of elevated magnesium levels on the cardiovascular system and neuromuscular function. Calcium gluconate is the appropriate medication for this condition because it acts as an antagonist to magnesium. Magnesium and calcium compete for binding at neuromuscular junctions and in the heart. By administering calcium gluconate, the nurse helps to stabilize the cardiac membrane and improve neuromuscular function, thus mitigating symptoms of hypermagnesemia.
Other Options:
- B. Flumazenil: This medication is a benzodiazepine antagonist used to reverse benzodiazepine overdoses, not relevant for hypermagnesemia.
- C. Protamine sulfate: This is used to reverse the effects of heparin, an anticoagulant, and is not applicable in the case of hypermagnesemia.
- D. Acetylcysteine: This medication is used as an antidote for acetaminophen toxicity and has no role in managing hypermagnesemia.
Clinical Application: In acute settings, especially when hypermagnesemia is causing severe cardiovascular symptoms like bradycardia or hypotension, immediate administration of calcium gluconate is crucial. It helps in stabilizing the cardiac membrane and reducing the risk of life-threatening arrhythmias. In addition to administering calcium gluconate, the nurse should also address the underlying cause of hypermagnesemia, such as discontinuing magnesium-containing medications or treating renal impairment. Monitoring of serum magnesium levels and ongoing patient assessment are essential to ensure effective management and recovery.