Hypermagnesemia is manifested by muscle weakness, hypotension, ECG changes, sedation and confusion. As plasma concentrations of magnesium begin to exceed 4 mEq/L the deep tendon reflexes are decreased and may be absent at levels approaching 10 mEq/L. A 12 to 15 mEq/L respiratory paralysis is a potential hazard; the respiratory effects can be antagonized to some extent by the intravenous administration of Calcium salts. In cases of severe renal impairment, symptomatic hypermagnesemia maybe an indication of dialysis. Although many usually tolerate high concentration of magnesium in plasma, there are occasional instances when cardiac consequences may be seen in the form of complete heart block at concentration below 10 mEq/L.
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