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Toxic Shock Syndrome
PEDIATRICS Vol. 112 No. 1 July 2003, pp. e70-e72

EXPERIENCE AND REASON

Iatrogenic Acute Hypermagnesemia After Total Parenteral Nutrition Infusion Mimicking Septic Shock Syndrome: Two Case Reports

Ayoob Ali, MD, Corinne Walentik, MD, Gregory J. Mantych, MD, H. Farouk Sadiq, MD, William J. Keenan, MD and Akhihiko Noguchi, MD

From the Division of Neonatology, Department of Pediatrics, Cardinal Glennon Children’s Hospital, St Louis University, St Louis, Missouri

Two premature newborn infants developed extreme magnesium toxicity while receiving total parenteral nutrition (TPN) infusion. Both patients exhibited acute hypotonia, apnea, hypotension, and refractory bradycardia mimicking septic shock syndrome. The complete blood count was normal, and blood cultures were negative. Serum magnesium concentration in 1 patient was 43.1 mEq/L and in the other patient was 45 mEq/L (normal values for serum magnesium being 1.6–2.1 mEq/L). Hypermagnesemia resulted from malfunction of an automated TPN mixing device. Unexplained sudden onset of apnea, refractory bradycardia, and hypotension should raise suspicions of hypermagnesemia, a reversible condition if identified and treated early.

Key Words: total parenteral nutrition • hypermagnesemia

Abbreviations: TPN, total parenteral nutrition • EEG, electroencephalogram

Received for publication Dec 26, 2002; Accepted Mar 13, 2003.




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G. G. Deshpande, V. Gharpure, A. P. Sarnaik, and R. P. Valentini
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Am. J. Health Syst. Pharm., February 1, 2006; 63(3): 262 - 265.
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