Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia
Fluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2019-06-01
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| Series: | Case Reports in Gastroenterology |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/501121 |
| _version_ | 1828841608491040768 |
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| author | Mark J. Makowsky Peter Bell Leah Gramlich |
| author_facet | Mark J. Makowsky Peter Bell Leah Gramlich |
| author_sort | Mark J. Makowsky |
| collection | DOAJ |
| description | Fluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn’s disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were <0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic visits. After initiation of subcutaneous magnesium sulfate, all magnesium concentrations were >0.60 mmol/L (mean 0.79 ± 0.08 mmol/L over 9 months). The patient tolerated the infusions well, only developing one minor episode of infusion-related cellulitis. A systematic review of the literature identified 14 reports where subcutaneous magnesium sulfatewas effective and treatment for adults or children with hypomagnesemia was safe. Home-based intermittent administration of subcutaneous magnesium may be a helpful and safe intervention to temporarily prevent and treat select patients with recurrent symptomatic hypomagnesemia. |
| first_indexed | 2024-12-12T20:06:53Z |
| format | Article |
| id | doaj.art-0a5e83e37582430694f2274e250689bf |
| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-12-12T20:06:53Z |
| publishDate | 2019-06-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-0a5e83e37582430694f2274e250689bf2022-12-22T00:13:36ZengKarger PublishersCase Reports in Gastroenterology1662-06312019-06-0113228029310.1159/000501121501121Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced HypomagnesemiaMark J. MakowskyPeter BellLeah GramlichFluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn’s disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were <0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic visits. After initiation of subcutaneous magnesium sulfate, all magnesium concentrations were >0.60 mmol/L (mean 0.79 ± 0.08 mmol/L over 9 months). The patient tolerated the infusions well, only developing one minor episode of infusion-related cellulitis. A systematic review of the literature identified 14 reports where subcutaneous magnesium sulfatewas effective and treatment for adults or children with hypomagnesemia was safe. Home-based intermittent administration of subcutaneous magnesium may be a helpful and safe intervention to temporarily prevent and treat select patients with recurrent symptomatic hypomagnesemia.https://www.karger.com/Article/FullText/501121MagnesiumSubcutaneous infusionsHypodermoclysisRadiation enteritisIleostomy |
| spellingShingle | Mark J. Makowsky Peter Bell Leah Gramlich Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia Case Reports in Gastroenterology Magnesium Subcutaneous infusions Hypodermoclysis Radiation enteritis Ileostomy |
| title | Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia |
| title_full | Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia |
| title_fullStr | Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia |
| title_full_unstemmed | Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia |
| title_short | Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia |
| title_sort | subcutaneous magnesium sulfate to correct high output ileostomy induced hypomagnesemia |
| topic | Magnesium Subcutaneous infusions Hypodermoclysis Radiation enteritis Ileostomy |
| url | https://www.karger.com/Article/FullText/501121 |
| work_keys_str_mv | AT markjmakowsky subcutaneousmagnesiumsulfatetocorrecthighoutputileostomyinducedhypomagnesemia AT peterbell subcutaneousmagnesiumsulfatetocorrecthighoutputileostomyinducedhypomagnesemia AT leahgramlich subcutaneousmagnesiumsulfatetocorrecthighoutputileostomyinducedhypomagnesemia |