Introduction
xxxxxxx xxxxxx, a 53-year old Caucasian male, was brought into emerge after he was found passed out drunk in the downtown streets of Peterborough, Ontario. Doctors thought that he would be fine when he awoke, but instead, Mr. xxxxxx awoke confused, complaining of fatigue, muscle cramps, muscle weaknesses and numbness, and he was also observed to have abnormal eye movements and convulsions (Efstratiadis et al. 2006). Further examination was required to determine what Mr. xxxxxx was suffering from. Based on his symptoms, doctors did a complete physical examination and took the following tests: blood, urine, a comprehensive metabolic panel diagnostic test, a DDX (differential diagnosis) and Electrocardiogram (ECG) changes (Efstratiadis et al. 2006).
Past Medical/Familial history:
- Significant past familial history included hypercholesterolemia and gastric esophageal reflux disease and no presence of chronic endocrine diseases.
- He denied the use of drugs
- He is an alcoholic
Test Results:
Height: 181cm
Weight: 131 lbs. (31 lbs. less than the ave. 5’9” male) (StatisticsCanada, 2009)
Blood pressure: 103/80 mmHg
Heart rate: 128 BPM
Respiration rate: 24 breaths/min
Physical examination: no abnormalities
Hemoglobin: 18.6 g/mL (reference: 11.7-15.3 g/mL)
Leukocyte count: 27.8×10^9 /L (reference: 3.5-11.0×10^9 /L)
Urea 8.6 mmol/L (reference: 2.6–6.4 mmol/L)
Magnesium 0.33 mmol/L (reference: 0.71-0.94 mmol/L)
Sodium 150 mmol/L (references: 137–145 mmol/L)
Potassium 3.6 mmol/L (references: 3.4–4.8 mmol/L)
Calcium 2.18 mmol/L (references: 2.17–2.52 mmol/L)
A urine test strip = positive on proteins (2+)
Electrocardiogram (ECG) : The corrected QT-interval was 388 ms.
Ultrasound of the kidneys were normal.
Urine production during first hours of admittance: 20mL/hour
Discussion
The results of the tests conducted by the doctors gave Mr. xxxxxx’s the diagnosis of hypomagnesemia. Hypomagnesemia is a deficiency of magnesium in the blood and magnesium is a critical mineral that regulates many important functions in the body, such as: muscle contraction, heart rhythm and nerve function (Agus, 1999). Hypomagnesemia can be caused by many different things, including: alcohol use disorder, malnutrition, malabsorption, chronic diarrhea, excessive sweating, heart failure, certain medications, including some diuretics (water pills used to control high blood pressure) and antibiotics (Agus, 1999). Hypomagnesemia can cause the body to have abnormal eye movements (nystagmus), convulsions, fatigue, muscle spasms or cramps, muscle weakness, numbness, confusion, hallucinations and seizures (Agus, 1999). Symptoms of hypomagnesemia typically begin to occur at serum levels of less than 0.66mmol/L and magnesium balance in the body is maintained by renal regulation of magnesium reabsorption (Agus, 1999).
The patient’s complaints and alcoholic past lead doctors to believe an electrolyte deficiency was the cause, and the blood work and other tests confirmed it was.
Hypomagnesemia was primarily diagnosed in this patient after his results for magnesium were 0.33 mmol/L, when the normal range for adults is between 0.71-0.94 mmol/L (Jahnen-Dechent et al. 2012).
Patients diagnosed with hypomagnesemia have an excellent prognosis, once the deficiency is corrected. For the most part, the symptoms are reversible with treatment (Agus, 1999). If hypomagnesemia is not diagnosed in time, severe hypomagnesemia can cause life-threatening ventricular arrhythmias (Agus, 1999).
Treatment for hypomagnesemia depends on the degree of magnesium deficiency and the symptoms that the patient is experiencing (Ayuk et al. 2014). Most hypomagnesemia cases are diagnosed early and the symptoms are usually mild, and the patients can be given oral replacement therapy (Ayuk et al. 2014). Mr. xxxxxx was discharged and was instructed to limit alcohol consumption, to take a daily oral supplement of magnesium to get his magnesium level back up to the normal range of 0.71-0.94 mmol/L and to alleviate his symptoms and was told to eat magnesium-rich foods (nuts and green vegetables) (Costello et al. 2016).
Hypomagnesemia can be life-threatening (cardiac arrest, respiratory arrest and death), so seeking medical assistance if these symptoms arise is important (Hansen et al. 2016). Lessons to be learned from this case include to attempt to prevent this disorder in the early stages before the issues start to arise (Hansen et al. 2016). Things to keep in mind include; those who play highly demanding sports activities should drink fluids containing electrolytes (sports drinks); drinking only water while participating in intensely demanding sports can result in acute hypomagnesemia. Other preventions include limiting alcohol intake and managing underlying health conditions (Grader et al. 2015).
Conclusion
Mr. xxxxxx was admitted to emerge after he found passed out in the streets from alcohol consumption. He suffered symptoms of fatigue, confusion, muscle cramps, muscle weakness, numbness, abnormal eye movements and convulsions. The tests conducted by the doctors indicated that hypomagnesemia was the cause of his symptoms. The patient’s main treatment plan was to take oral magnesium therapy and to eat magnesium-rich foods to bring the magnesium levels in his body back to what is considered to be normal for an adult.