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ACUTE EXPOSURE INFORMATION

1. USES: Magnesium is available in many forms and has many different medical uses, including as an antacid and laxative, anticonvulsant, treatment of torsades de pointes, pre-eclampsia, management of acute asthma exacerbation, hydrofluoric acid ingestion, enema, and electrolyte supplement. Magnesium is an essential electrolyte in the body and is a cofactor in many enzyme systems. Industrially, magnesium is used as a component of aluminum alloys, in die-casting alloyed with zinc, to remove sulfur in the production of iron and steel, and for the production of titanium.

2. PHARMACOLOGY: When taken orally, magnesium promotes bowel evacuation by osmotic retention of fluid which distends the colon and increases peristaltic activity. Parenteral magnesium decreases acetylcholine in motor nerve terminals and acts on myocardium by slowing rate of S-A node impulse formation and prolonging conduction time as well as stabilizing excitable membranes. Magnesium is also necessary for the movement of other electrolytes (calcium, sodium and potassium) in and out of cell.

3. TOXICOLOGY: In overdose, magnesium impairs neuromuscular transmission, manifested as weakness and hyporeflexia.

4. EPIDEMIOLOGY: Thousands of exposures occur every year, but severe manifestations are very rare. Severe toxicity is most common after intravenous infusion over multiple hours (usually for pre-eclampsia), and can occur after chronic excessive doses, especially in the setting of renal insufficiency. Severe toxicity has been reported after acute ingestion but is very rare.

5. WITH THERAPEUTIC USE
   1. Adverse effects seen with magnesium sulfate include adverse effects on neuromuscular function and flushing (IV, dose-related), hypotension (IV, rate-related), and vasodilation (IV, rare-related). Magnesium sulfate may also cause diarrhea. Magnesium hydroxide has many drug interactions secondary to its antacid effect.

6. WITH POISONING/EXPOSURE
   1. MILD TO MODERATE TOXICITY: Nausea and vomiting are common with oral exposure. Flushing can occur most often with intravenous administration. Magnesium dust can irritate the eye and mucous membranes of the upper respiratory tract causing an atrophic nasopharyngitis. Metal fume fever can result from inhalation of magnesium fumes.
   2. SEVERE TOXICITY: Severe toxicity occurs most often after intravenous infusions. It can also occur after chronic excessive oral doses, often in patients with renal insufficiency. Early manifestations are lethargy, hyporeflexia, followed by weakness, paralysis, hypotension, ECG changes (prolonged PR and QRS intervals), CNS depression, seizures, and respiratory depression.

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