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Hypomagnesemia causes cognitive and sensory problems, increased tendon reflexes, positive Chvosteks and Trousseaus signs, elevated blood pressure and pulse, dysrhythmias, and electrocardiogram changes. Hypermagnesemia (serum magnesium >2.5 mEq/L) is caused by excessive intake of solutions containing phosphates, hypoparathyroidism, laxatives containing phosphate, and renal insufficiency. Hypermagnesemia causes tetany, muscle weaknesses and paralyses, tachycardia, electrocardiogram changes, and gastrointestinal disturbances.
How do the acid-base disturbances (respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis) differ?
Respiratory acidosis (carbonic acid excess) is an acid-base disturbance characterized by a blood pH below 7.35, arterial carbon dioxide pressure greater than 45 mm Hg, and an excess of carbonic acid. Respiratory acidosis is caused by hypoventilation or depressed ventilation. Respiratory acidosis causes disorientation, weakness, stupor, flushed and warm skin and mucous membranes, dyspnea, tachycardia, and dysrhythmias. Respiratory alkalosis (carbonic acid deficit) is characterized by decreased hydrogen ion concentration (blood pH above 7.45) and an arterial carbon dioxide pressure less than 35 mm Hg. Respiratory alkalosis is caused by hyperventilation (excessive exhalation of carbon dioxide, leading to hypocapnia (decreased arterial dioxide concentration). Respiratory alkalosis causes hyperactive reflexes, sweating, rapid and shallow breathing, and palpitations. Metabolic acidosis (bicarbonate deficit) is characterized by an increased hydrogen ion concentration (blood pH below 7.35) or a decrease in bicarbonate concentration. It can be caused by a loss of base such as the loss of bicarbonate and sodium ions from the small intestines with chronic diarrhea, or a gain in metabolic acids cased by diabetic ketoacidosis, renal failure, anerobic metabolism, or drug overdose. Metabolic acidosis causes disorientation and shift of hydrogen and sodium ions into the cell. Potassium then
moves into the extracellular fluid, causing ventricular fibrillation and death. Metabolic alkalosis (bicarbonate excess) is characterized by a blood pH above 7.45. It is caused by excess ingestions of antacids or sodium bicarbonate or a loss of metabolic acids through vomiting, nasogastric suctioning, low potassium or chloride, increased aldosterone, or administration of steroids or diuretics. Symptoms are irritability confusion, tetany, hypertonic muscles and reflexes, depressed respirations, and vomiting.
What are the Chvosteks and Trousseaus signs and what do they mean?
Chvosteks sign and Trousseaus sign are tests for neuromuscular irritability. Chvosteks sign is elicited by tapping the facial nerve 2 cm anterior to the earlobe. A positive response is ipsilateral (same side) twitching of the facial muscles. Trousseaus sign is elicited by placing a blood pressure cuff on the arm, inflating the cuff slightly above the systolic pressure, leaving the cuff inflated 2 to 3 minutes, and deflating. A carpal spasm is a positive response. A positive Chvosteks sign and Trousseaus sign indicate hypocalcemia or hypomagnesemia.