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Hypermagnesaemia — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesHypermagnesaemiaSCE Acute Medicine

A 71-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show renal failure, reduced reflexes, respiratory depression and magnesium 4.8. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give intravenous calcium and arrange dialysis if severe

The key discriminator is that renal failure, reduced reflexes, respiratory depression and magnesium 4.8, which makes Give intravenous calcium and arrange dialysis if severe the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF magnesium salts