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Myasthenia gravis presenting as weakness after magnesium administration
Author(s) -
Bashuk Robert G.,
Krendel David A.
Publication year - 1990
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.880130808
Subject(s) - myasthenia gravis , neuromuscular transmission , medicine , magnesium , anesthesia , neuromuscular junction , postsynaptic potential , repetitive nerve stimulation , neuromuscular blockade , weakness , stimulation , neuromuscular disease , paralysis , surgery , chemistry , psychology , disease , receptor , neuroscience , organic chemistry
We studied a patient with no prior history of neuromuscular disease who became virtually quadriplegic after parenteral magnesium administration for preeclampsia. The serum magnesium concentration was 3.0 mEq/L, which is usually well tolerated. The magnesium was stopped and she recovered over a few days. While she was weak, 2‐Hz repetitive stimulation revealed a decrement without significant facilitation at rapid rates or after exercise, suggesting postsynaptic neuromuscular blockade. After her strength returned, repetitive stimuation was normal, but single fiber EMG revealed increased jitter and blocking. Her acetylcholine receptor antibody level was markedly elevated. Although paralysis after magnesium administration has been described in patients with known myasthenia gravis, it has not previously been reported to be the initial or only manifestation of the disease. Patients who are unusually sensitive to the neuromuscular effects of magnesium should be suspected of having an underlying disorder of neuromuscular transmission.