 Hi, and welcome to nursing school. Explain this video on magnesium imbalances. So we'll take a look at causes of hypo, as well as hyper-magnosemia. So as a quick reference here, magnesium levels are typically 1.5 to 2.5 in the serum. But as always, remember to look at the references for the specific lab that you're working with to make sure that you have the correct reference range. And as a quick refresher, magnesium is a major intracellular fluid electrolyte. So it lives, most of the magnesium lives within our cells. And it's very closely related to potassium. So it likes to travel with potassium. That means that typically when magnesium levels are low, potassium levels will be low. When magnesium levels are high, potassium levels will be high. And magnesium is in charge of muscle relaxation. While the potassium is more in charge of that sodium and potassium pump helping with the muscle contraction, magnesium helps with the relaxation. And therefore we always have to think about the heart muscle as well as the neuromuscular junction or the neuromuscular function. And that those are muscles of the skeletal muscles, as well as the smooth muscles in the organs, especially our GI tract. So now causes for low magnesium levels are number one, diarrhea. That's just like in potassium, when we have a lot of diarrhea fluid losses through the GI tract, we on the lower end, then we can encounter patients with hypomagnosemia. But also gastric suctioning. So when there's a lot of fluid removed from the gastric tract, we can lose magnesium there too. Burn victims as well as chronic kidney disease patients. And then alcoholism here is a big one. So many patients who are chronically alcohol dependent drink a lot of alcohol and they will have chronically low levels of magnesium. And we'll look later on to signs and symptoms to see what that can cause. And also malnutrition and eating disorders. And that is mostly related to the magnesium that we lose from like binging and purging. Think about bulimia or anorexia nervosa, any of those things. Now for hypermagnosemia, so increased levels of magnesium, they can be high because of an increased intake of magnesium containing anti-acids. So it's just simple anti-acids that somebody might be taking for their stomach problems or upset stomach or kind of heartburn issues, as well as laxatives because they all contain magnesium. So if the patient takes too many, the magnesium level can go high. And then also, if magnesium is administered in the IV and that's a treatment actually that's indicated for certain conditions, that would be preeclampsia. If the patient is going to almost like preterm labor and we wanna relax that uterus, that smooth muscle because magnesium helps with muscle relaxation, we can administer IV magnesium, but it can cause hypermagnosemia because we're just administering too much or a lot of it. And as well as asthma, asthma is a condition where the bronchioles are kind of contract and tight and very constricted. So when we relax the muscles of the respiratory tract, it'll help alleviate the patient's respiratory symptoms. But again, in turn, it can lead to hypermagnosemia. And then for twice the points, and I'll go talking about that in a moment here in more detail. So then in terms of signs and symptoms, because we know magnesium helps with muscle relaxation, we always have to think about muscles when we think about signs and symptoms. And so again, those are muscles of the cardiac tissue as well as skeletal and smooth muscles. So for low magnesium levels, it can cause dysrhythmias. Over here we said that patients with alcoholism can have chronically low levels of magnesium. And towards us the point is a special kind of arrhythmia. So VTAC, ventricular tachycardia is characterized by wide QRS complexes. But it's very uniform here. You can see all these QRS complexes have the same height. So they're pretty even when it comes to this here. Where to start the point, this is a special type of VTAC. We still have the wide and bizarre looking QRS complexes, but it's not all in one straight line. It kind of goes in this up and down motion. So these QRS complexes get wider or deeper and not so high on the EKG as we would see. So they kind of follow this pattern here. And then if you see that on the monitor, right away you should think about hypomagnesemia. So if but in addition to torsades, hypomagnesemia can cause regular VTAC, V-fib, preventricular contractions and can go as far as cardiac arrest because the muscles just don't have the ability to relax because we are low on magnesium levels and everything is just super hyper excitable. That same pertains to the neuromuscular junction. So everything is hyper excitable because we have low magnesium. We can't relax those muscles, which will also increase our deep tendon reflexes being hyperactive. It can lead to muscle cramps because we just don't have the ability to relax the muscles and the patient will also have a positive swastik and true soul sign and those are pretty telltale. So I'll go over those in a different video but please soak those up if you're not familiar with those two things or those two names. And then for hypermagnesemia, very similar. Again, this rithmias but this time because we are having too much magnesium on board so rather than being hyper excitable we're kind of relaxing the cardiac muscle too much because magnesium is in charge of the muscle relaxation. So now everything will be slow. That can be bradycardia, everything slows down. That can be a hard block and it can all the way lead again to cardiac arrest. In terms of the neuromuscular junction instead of hyper excitable as with low magnesium the muscles will be weak so they'll be kind of more lax and weak and then the deep tendon reflexes will be low or down or not as excitable. In terms of treatment, so when we have low potassium levels we wanna replenish that and the only two options are by PO or IV magnesium. Magnesium IV administration is not as critical or as we don't have to as carefully monitor it as potassium but as with any electrolyte whenever we administer it we wanna make sure that we have the patient on the cardiac monitor because we know it's gonna relax their heart muscle and then we can monitor them very carefully but it doesn't have the caustic effects on the vein that the potassium would have. And then in terms of if we have too much magnesium we wanna discontinue any magnesium containing products or medications such as in the conditions that we talked about over here. If the level is too high and just a discontinuation won't bring the level down to normal or the patient has significant symptoms that pertain to the heart the patient might have to go on hemodialysis to filter out that extra magnesium that's present. IV calcium gluconate also helps to neutralize the magnesium and then we can also use lube diuretics to try and get the magnesium to be excreted through the kidneys. As for nursing care we wanna monitor our vital signs because we know it affects the muscles of not only the heart but also the smooth muscle and that includes the blood vessels and then we wanna keep the patient on the heart monitor because we wanna keep a look on this muscular relaxation. We wanna check the neuromuscular function so for generalized weakness, muscle cramping check those deep tendon reflexes. Certainly we wanna keep an eye on their lab values magnesium as well as potassium because we know that they work together and then also calcium which is another electrolyte that pertains to muscle contraction and the way that muscles work. We wanna initiate for precautions because any of these signs and symptoms or higher or low levels can make the muscles not work as properly and therefore the patient can be weak or hyper excitable making them at more at higher risk for fall and then certainly we wanna make sure we have a good IV access not only to give the replacement but also maybe get them ready for hemodialysis and monitor them very carefully. One more tidbit. If you're interested in the dysrhythmias here and how that relates, I have a special video in the EKG playlist that goes into VTAC where I talk about torso also. So thank you for watching this video here on magnesium imbalances. Please also check out the other electrolyte imbalances in the Fluidine Electrolyte playlist and I'll see you soon right here on Nursing School Explained. Thanks for watching.