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Makowsky MJ, Bell P, Gramlich L. Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia. Case Rep Gastroenterol. 2019;13(2):280-293doi: 10.1159/000501121.
Makowsky, M. J., Bell, P., & Gramlich, L. (2019). Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia. Case reports in gastroenterology, 13(2), 280-293. https://doi.org/10.1159/000501121
Makowsky, Mark J, et al. "Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia." Case reports in gastroenterology vol. 13,2 (2019): 280-293. doi: https://doi.org/10.1159/000501121
Makowsky MJ, Bell P, Gramlich L. Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia. Case Rep Gastroenterol. 2019 Jun 26;13(2):280-293. doi: 10.1159/000501121. eCollection 2019. PMID: 31341460; PMCID: PMC6639584.
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Case Rep Gastroenterol. 2019 Jun 26;13(2):280-293. doi: 10.1159/000501121. eCollection 2019.

Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia.

Case reports in gastroenterology

Mark J Makowsky, Peter Bell, Leah Gramlich

Affiliations

  1. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
  2. Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
  3. Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

PMID: 31341460 PMCID: PMC6639584 DOI: 10.1159/000501121

Abstract

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.

Keywords: Hypodermoclysis; Ileostomy; Magnesium; Radiation enteritis; Subcutaneous infusions

Conflict of interest statement

The authors have no conflicts of interest to declare.

References

  1. Dtsch Med Wochenschr. 2000 Aug 18;125(33):970-2 - PubMed
  2. Dtsch Med Wochenschr. 2001 Jan 26;126(4):96 - PubMed
  3. QJM. 2002 Jan;95(1):37-40 - PubMed
  4. Clin Nutr. 2005 Feb;24(1):158-63 - PubMed
  5. Nat Clin Pract Gastroenterol Hepatol. 2005 Dec;2(12):604-8; quiz 609 - PubMed
  6. Gut. 2006 Aug;55 Suppl 4:iv1-12 - PubMed
  7. J Palliat Med. 2007 Aug;10(4):861-4 - PubMed
  8. J Pediatr Endocrinol Metab. 2008 Apr;21(4):385-91 - PubMed
  9. Oncol Nurs Forum. 1991 Sep-Oct;18(7):1145-52 - PubMed
  10. Nutr Hosp. 2009 May-Jun;24(3):354-6 - PubMed
  11. Colorectal Dis. 2011 Feb;13(2):191-7 - PubMed
  12. Br J Nurs. 2012 Mar 22-Apr 11;21(6):S22-5 - PubMed
  13. Psychol Methods. 2013 Jun;18(2):165-85 - PubMed
  14. Anesth Pain Med. 2015 Dec 05;5(6):e30643 - PubMed
  15. J Clin Diagn Res. 2016 Apr;10(4):UC18-22 - PubMed
  16. Neth J Med. 2017 Jan;75(1):35-38 - PubMed
  17. BMJ Support Palliat Care. 2018 Jun;8(2):191-193 - PubMed
  18. J Clin Endocrinol Metab. 1987 Dec;65(6):1301-4 - PubMed
  19. Emerg Med Clin North Am. 1984 Feb;2(1):145-58 - PubMed
  20. Aliment Pharmacol Ther. 1994 Dec;8(6):563-77 - PubMed
  21. Am J Emerg Med. 1998 Sep;16(5):521-2 - PubMed

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