Le magnésium est beaucoup utilisé en anesthésie-réanimation. On dispose de deux formes pour une administration IV : le sulfate de magnésium (MgSO4) et le chlorure de Magnesium (MgCl2).
Lorsque j’étais externe, j’avais une fascination pour les troubles hydro-électrolytiques, je ne sais pas pourquoi, mais j’adorais ça. Je suis rapidement passé en réa, espérant découvrir plein de choses sur le ionogramme. J’ai été un peu déçu, la défaillance rénale bouleversant les raisonnements physipathologiques alambiqués. Mais un interne de néphrologie qui a eu une grande influence sur ma formation médicale m’a bien appris que lorsqu’on avait une hypokaliémie en face des yeux sur les analyses sanguines, il fallait toujours apporter du magnésium pour donner toutes les chances au patient de remonter sa kaliémie.
Lorsque l’on a retenu ça, on n’a fait que la moitié de l’apprentissage. Il faut ensuite comprendre que c’est le chlorure de magnésium qui donnera les meilleurs résultats pour corriger l’hypokaliémie. En effet lors de l’administration de sulfate de magnesium, le sulfate n’est pas réabsorbable au niveau rénal et il s’en suit une perte urinaire de potassium pour des histoires d’électroneutralité.
Merci Boubou.
P.S. notez par contre que je ne dose pour ainsi dire jamais le magnésium, en effet je ne sais pas si le dosage plasmatique ou érythrocytaire apporte quelque chose à notre réflexion. Une magnésémie normale dans le plasma n’exclue pas du tout un déficit intracellulaire (au niveau cardiaque par exemple)
P.P.S Je vous conseille vivement la présentation sur l’hypokaliémie chez Vincent Bourquin, sur le blog NephroHUG
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5 réponses sur « Magnésium et hypokaliémie »
Devant toute hypokaliémie il faut doser le magnésium et j’irai même plus loin il faut faire une FE du Mg, il va vraiment falloir que je mette en ligne un jour mon cours sur la magnésémie. J’adore le Mg, c’est un des ions les plus fascinant qui existe, surtout versant maladie génétique. Pour voir des hypomagnésémies d’origine génétique dont une historique, je t’assure que quand la magnésémie se normalise dans le sans pas mal de symptomes s’améliorent
Merci pour ton conseil.
En fait je pense que tu vois des patients avec des hypokaliémies « chroniques » bien plus régulièrement que nous. Chez nous en chirurgie, entre les iléostomies, la SNG, le glucosé, les diurétiques pour le poumon qui se mouille, la dénutrition, l’insuline, l’alcoolisme, la renutrition on fait plutôt fasse à des kaliémies qui descendent gentiment vers 3 et qui remonte facilement avec la supplémentation IV.
On dose déjà tellement de trucs inutiles en périopératoire (mon combat : convaincre les internes de ne pas prescrire de iono ou de coag en post-op immédiat) que je ne sais pas si on ne se ferait pas trop avoir par les faux négatifs avec une magnésémie plasmatique satisfaisante alors qu’il y a une dépletion du pool global. C’est pourquoi je donne du magnésium au bloc et en post-op en quantité « raisonnable » sans faire de dosage spécifique vu l’index thérapeutique confortable.
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