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Background <p>Hypermagnesemia in a surgical patient potentially causes arrhythmias, whereas it rarely induces devastating outcomes, including cardiac arrest, in the perioperative period. Here, we present a woman who underwent an emergent colostomy owing to impending bowel rupture, immediately after cardiac arrest caused by severe hypermagnesemia due to the magnesium-containing laxative overdose prescribed for chronic constipation and fecal obstruction.</p> Case presentation <p>An 81-year-old woman with chronic constipation developed fecal obstruction despite a large volume of magnesium-containing laxatives to relieve her constipation. She visited our emergency department because she felt severe abdominal pain continuously. Shortly after she arrived at the emergency department, she developed abrupt cardiac arrest, and she was successfully resuscitated by ordinary treatments, including 1&#xa0;mg of intravenous (IV) adrenaline. Her laboratory test on arrival revealed a serum magnesium level of 18.3&#xa0;mg/dL. Our surgeons diagnosed her condition as impending bowel rupture, and therefore, they proceeded with an emergent colostomy without preceding renal replacement therapy. We implemented the following procedures to decrease her serum magnesium level: an intravenous 425&#xa0;mg calcium gluconate, 20&#xa0;mg of a loop diuretic furosemide, and a large-volume crystalloid infusion, resulting in her serum magnesium level of 12.8&#xa0;mg/dL during her surgical procedure. The postoperative use of two hemodialysis session led to a normal range of serum magnesium (2.8&#xa0;mg/dL). The patient’s postoperative course was uneventful, and she was discharged on postoperative day 37.</p> Conclusions <p>The current case report documented that magnesium-containing laxative overdose causes severe hypermagnesemia, resulting in abrupt cardiac arrest, and that a specific emergency surgical procedure is feasible with efforts to decrease the serum magnesium level. However, we argue that implementation of renal replacement therapy, including continuous hemodiafiltration, in addition to surgical intervention, might be one of the best management strategies in a patient with severe hypermagnesemia in combination with an impending surgical problem.</p>

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Perioperative management in a patient immediately after cardiac arrest caused by severe hypermagnesemia due to magnesium-containing laxative overdose: a case report

  • 期刊论文

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  • 发表日期：

    2026年6月21日

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  • Hiroki Anezaki,
  • Shingo Kawashima,
  • Atsushi Kobayashi,
  • Wakana Kawashima,
  • Masahiko Ohashi,
  • Hiroyuki Kinoshita

摘要

Background

Hypermagnesemia in a surgical patient potentially causes arrhythmias, whereas it rarely induces devastating outcomes, including cardiac arrest, in the perioperative period. Here, we present a woman who underwent an emergent colostomy owing to impending bowel rupture, immediately after cardiac arrest caused by severe hypermagnesemia due to the magnesium-containing laxative overdose prescribed for chronic constipation and fecal obstruction.

Case presentation

An 81-year-old woman with chronic constipation developed fecal obstruction despite a large volume of magnesium-containing laxatives to relieve her constipation. She visited our emergency department because she felt severe abdominal pain continuously. Shortly after she arrived at the emergency department, she developed abrupt cardiac arrest, and she was successfully resuscitated by ordinary treatments, including 1 mg of intravenous (IV) adrenaline. Her laboratory test on arrival revealed a serum magnesium level of 18.3 mg/dL. Our surgeons diagnosed her condition as impending bowel rupture, and therefore, they proceeded with an emergent colostomy without preceding renal replacement therapy. We implemented the following procedures to decrease her serum magnesium level: an intravenous 425 mg calcium gluconate, 20 mg of a loop diuretic furosemide, and a large-volume crystalloid infusion, resulting in her serum magnesium level of 12.8 mg/dL during her surgical procedure. The postoperative use of two hemodialysis session led to a normal range of serum magnesium (2.8 mg/dL). The patient’s postoperative course was uneventful, and she was discharged on postoperative day 37.

Conclusions

The current case report documented that magnesium-containing laxative overdose causes severe hypermagnesemia, resulting in abrupt cardiac arrest, and that a specific emergency surgical procedure is feasible with efforts to decrease the serum magnesium level. However, we argue that implementation of renal replacement therapy, including continuous hemodiafiltration, in addition to surgical intervention, might be one of the best management strategies in a patient with severe hypermagnesemia in combination with an impending surgical problem.