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