Hypermagnesemia & Hypomagnesemia (Magnesium Imbalances) Nursing Care Plans


This article provides an in-depth overview of hypermagnesemia and hypomagnesemia nursing care plans and nursing diagnosis. Learn about the causes, symptoms, nursing interventions and management options for magnesium imbalances.

Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia

Magnesium (Mg) is the second most abundant cation in the intracellular fluid. Magnesium functions by exerting its effects on the myoneural junction, affecting neuromuscular irritability. It also plays an important role in the contraction of cardiac and skeletal muscles cells; contributes to vasodilation and through this effect, changes blood pressure and cardiac output; activates intracellular enzymes to participate in carbohydrate and protein metabolism, and influences intracellular calcium levels through its effect on parathyroid hormone secretion.

The normal serum magnesium concentration ranges from 1.3 to 2.1 mEq/L.

  • Hypermagnesemia is serum magnesium levels above 2.1 mEq/L.
  • Hypomagnesemia is serum magnesium levels below 1.3 mEq/L.

Nursing Care Plans

Magnesium imbalances, including hypermagnesemia and hypomagnesemia, require careful management to prevent potentially serious complications. The nursing care plan goals for patients with magnesium imbalances are focused on restoring magnesium levels to a safe range and managing associated symptoms and complications.

Here are two nursing diagnosis for patients with magnesium imbalances: hypermagnesemia & hypomagnesemia nursing care plans:

  1. Hypermagnesemia: Risk for Electrolyte Imbalance
  2. Hypomagnesemia: Risk for Electrolyte Imbalance

Hypermagnesemia: Risk For Electrolyte Imbalance

Hypermagnesemia, an elevated level of magnesium in the blood, can lead to a risk of electrolyte imbalance, as it may affect the normal functioning of cells and organs, including the heart and nervous system. This can occur due to various reasons, including excessive intake of magnesium-containing supplements, medications or antacids, and medical conditions affecting the kidneys or hormonal regulation of magnesium balance. Symptoms of hypermagnesemia may include weakness, confusion, respiratory and cardiac distress, and coma.

Nursing Diagnosis

  • Risk for Electrolyte Imbalance

May be related to

  • Chronic diarrhea
  • Diabetic ketoacidosis
  • Renal dysfunction
  • Treatment-related side effects such as medications containing magnesium, dialysis with hard water, diuretic abuse

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • The client will display heart rhythm, muscular strength, cognitive status, and laboratory results within the normal limit for the client and the absence of respiratory impairment.

Nursing Assessment and Rationales

Nursing assessment is a crucial aspect of managing hypermagnesemia, an electrolyte imbalance characterized by serum magnesium levels greater than 2.1 mg/dL. A thorough nursing assessment of clinical presentation, medical history, and diagnostic tests is necessary to prevent complications associated with hypermagnesemia.

1. Monitor respiratory rate and depth. Encourage deep breathing and coughing exercise. Elevate the head of the bed.
Neuromuscular transmissions are blocked by excess magnesium, resulting in respiratory muscular weakness, and hypoventilation, which may proceed to apnea.

2. Monitor blood pressure.
Hypotension unexplained by other causes is an early sign of magnesium toxicity. Hypermagnesemia can cause vasodilation, which can lead to a drop in blood pressure, and potentially cause cardiovascular collapse. As a result, blood pressure monitoring is necessary to detect any fluctuations and to initiate prompt interventions to prevent adverse outcomes.

3. Monitor heart rate and rhythm.
Bradycardia and heart block may develop, progressing to cardiac arrest as a direct result of hypermagnesemia in cardiac muscle.

4. Monitor urinary output and 24-hour fluid balance.
Renal failure is the primary contributing factor in hypermagnesemia, and if it is present, a fluid excess can easily occur.

5. Assess the level of consciousness and neuromuscular status, including reflexes, muscle movement, tone, and strength.
CNS and neuromuscular depression can cause a decreasing level of alertness, progressing to coma, and depressed muscular response, progressing to flaccid paralysis.

6. Check patellar reflexes regularly.
The absence of these reflexes indicates magnesium levels of about 7 mEq/L or greater. If untreated, cardiac and respiratory arrest can occur.

7. Monitor laboratory results as indicated.
Evaluate therapy needs and effectiveness.

Nursing Interventions and Rationales

1. Encourage bed rest; assist with personal activities, as needed.
Flaccid paralysis, lethargy, and decreased mentation can reduce activity tolerance and ability.

2. Encourage increased fluid intake, if appropriate.
Increased hydration promotes the excretion of magnesium, however, fluid intake must be cautious in the event of cardiac or renal failure.

3. Instruct the avoidance of magnesium-containing antacids such as Maalox, Mylanta, Riopan, and Getusil, in a client with renal disease. Caution for clients with renal diseases to avoid over-the-counter drug use without discussing it with the health care provider.
Limits oral intake to help avoid increased magnesium.

4. Administer medications as indicated:

  • 4.2. 10% Calcium chloride or calcium gluconate
    Antagonize action and reverses symptoms of magnesium toxicity to improve neuromuscular function.

5. Prepare, and assist with dialysis, as needed.
Dialysis may be indicated to lower magnesium levels, in case of the presence of renal failure.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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