We considered acute coronary syndrome (ACS) as one of the potential
causes of ECG issues such as ST changes. However, as the patient did not
experience any chest pain or dyspnea and had no prior history of cardiac
symptoms or risk factors for ACS, we instead suspected hypermagnesemia
as the underlying cause for the ECG changes. Additionally, the patient’s
family history did not indicate any coronary cardiac problems.
Treatment
The patient had no clinical changes, her Glasgow Coma scale (GCS) score
was 4/15. After receiving supportive care with intravenous isotonic
fluids and calcium gluconate to prevent cardiac complications, it was
decided to do hemodialysis for the patient. The decision to undergo
hemodialysis was based on Micromedex toxicology reference, which
recommends hemodialysis for severe magnesium toxicity. Then, after 4
hours of hemodialysis, serum Mg concentration became 3.1 mEq/L, calcium
6 mg/dl, and phosphorus 0.6 mg/dl, and her consciousness became better
with a GCS score of 7/15. The patient’s condition significantly
improved, as evidenced by clinical observations, laboratory tests, and
ECG, after spending 24 hours in the intensive care unit (ICU) in
intubated condition. The day after, the patient was extubated, and she
had normal respiratory rate and O2 saturation (image 2) (table 1).
Image 2 – ECG after hemodialysis