Severe Hypermagnesemia Following Rectal Magnesium Laxative Use Complicated by Non-Occlusive Mesenteric Ischemia: A Case Report

Abstract

We report the case of an 83-year-old female with a history of hypertension and neurological sequelae, including right eye visual impairment and right upper extremity motor deficit. She presented to the emergency department with altered mental status, abdominal pain, hypotension, and bradycardia following rectal administration of a magnesium-containing laxative. Laboratory analysis revealed severe hypermagnesemia (8.56 mg/dL), acute kidney injury, metabolic acidosis, elevated lactate (10 mmol/L), and markedly increased inflammatory markers. Contrast-enhanced abdominal computed tomography demonstrated diffuse small bowel wall thickening with decreased mural enhancement and mesenteric edema, consistent with non-occlusive mesenteric ischemia. Despite aggressive fluid resuscitation, vasopressor support, broad-spectrum antibiotics, and emergency surgical resection of necrotic bowel segments, the patient developed multiorgan failure and died on postoperative day nine.