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Periton Diyalizi Hastasında Acil Hemodiyaliz Gereksinimi; Laksatif Kullanımına Bağlı Hipermagnezemi: Olgu Sunumu

Requirement of Emergency Hemodialysis in a Peritoneal Dialysis Patient; Laxative Induced Hypermagnesemia: A Case Report

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DOI: 
DOI 10.5262/tndt.2013.1001.17

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Abstract (2. Language): 
Hypermagnesemia is rarely seen in peritoneal dialysis (PD) patients because PD can lower the plasma magnesium (Mg) concentration effectively. In this report, a continuous ambulatory peritoneal dialysis (CAPD) patient with life-threatening hypermagnesemia treated by hemodialysis (HD) is presented. A 52-year-old male patient on PD treatment was admitted to our clinic with complaints of fatigue and muscle weakness. Decrease in deep tendon reflexes (DTR), decrease in muscle strength at bilateral upper and lower extremities, and increased level of magnesium (7.7 mg/dl) were detected. Bradycardia, prolongation of the P-R interval, and an increase in Q-T interval were found on the electrocardiography. HD was performed two times. After HD, all the signs and symptoms of the patient improved. HD is a dialysis modality that should be preferred in the treatment of symptomatic patients with hypermagnesemia, because of providing more rapid clearance of Mg.
Abstract (Original Language): 
Periton diyalizi (PD) tedavisi plazma magnezyum (Mg) konsantrasyonunu etkin olarak düşürdüğünden PD hastalarında hipermagnezemi oldukça nadir görülmektedir. Burada, sürekli ayaktan periton diyalizi (SAPD) tedavisi alan bir hastada Mg hidroksit kullanımına bağlı ortaya çıkan, hayatı tehdit eden hipermagnezemi tablosunun acil hemodiyalizle (HD) düzeltildiği bir olgu sunulmuştur. Elli iki yaşında erkek hasta son dönem böbrek yetmezliği (SDBY) nedeniyle SAPD tedavisi uygulamaktayken, halsizlik ve kas güçsüzlüğü yakınmalarıyla polikliniğimize başvurdu. Hastanın yapılan nörolojik muayenesinde; derin tendon reflekslerinde (DTR) ve bilateral alt ve üst ekstremitelerdeki kas gücünde azalma ile birlikte magnezyum düzeyinde artış (7,7 mg/dl) saptandı. Hastanın çekilen elektrokardiyografisinde (EKG) bradikardi, P-R mesafesinde ve Q-T intervalinde uzama mevcuttu. Hasta 2 kez HD’e alındı. Sonrasında hastanın belirti ve bulguları düzeldi. Semptomlu hipermagnezemik hastalarda HD tedavisi daha hızlı Mg klirensi sağlayacağından tercih edilmesi gereken diyaliz modalitesidir.
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