Successful treatment of tetanus with magnesium in a dialysis patient

概要

鳥取大学研究成果リポジトリ

Tottori University research result repository
タイトル
Title

Successful treatment of tetanus with magnesium in a
dialysis patient

著者
Auther(s)

Mae, Yukari; Takata, Tomoaki; Isomoto, Hajime

掲載誌・巻号・ページ
Citation

THERAPEUTIC APHERESIS AND DIALYSIS , 24 (5) : 608 609

刊行日
Issue Date

2020-09-21

資源タイプ
Resource Type

その他 / Others

版区分
Resource Version

著者版 / Author

権利
Rights

(C) 2019 International Society for Apheresis,
Japanese Society for Apheresis, and Japanese
Society for Dialysis Therapy. This is the peer
reviewed version of the following article:
[THERAPEUTIC APHERESIS AND DIALYSIS. 2020. 24(5).
608-609.], which has been published in final form at
[doi:10.1111/1744-9987.13459]. This article may be
used for non-commercial purposes in accordance with
Wiley Terms and Conditions for Use of Self-Archived
Versions.

DOI

10.1111/1744-9987.13459

URL

https://repository.lib.tottori-u.ac.jp/9963

Accepted Article

Successful treatment of tetanus with magnesium in a dialysis patient

Yukari Mae, Tomoaki Takata, and Hajime Isomoto
Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University

All correspondence concerning this paper should be addressed to:
Tomoaki Takata, M.D., Ph.D.
Division of Medicine and Clinical Science, Department of Multidisciplinary Medicine,
Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, Tottori 683-8504,
Japan.

E-mail address: t-takata@tottori-u.ac.jp
Tel: +81-859-38-6527; Fax: +81-859-38-6529

Running title: Magnesium for tetanus in hemodialysis patient

Received: September 27, 2019
Revised: November 21, 2019

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which
may lead to differences between this version and the Version of Record. Please cite this
article as doi: 10.1111/tap.13459
This article is protected by copyright. All rights reserved.

Accepted Article

Dear Editor:
Tetanus is a life-threatening disease caused by Clostridium tetani infection. The
clinical manifestation includes spasms and autonomic nervous system disturbance.
Neurotoxin from the microbe blocks neurotransmitter release from the inhibitory
pathways of the motor and autonomic nervous system (1), resulting in the
overactivation of sympathetic nerve and extreme hypertension. Hypotension and
bradycardia, often seen in severe cases, are attributed to a sudden withdrawal of
sympathetic activity, and controlling rapid fluctuation of the hemodynamics is difficult
in such patients.
An 87-year-old man with end-stage renal disease (ESRD) on maintenance
hemodialysis (HD) was admitted to the hospital with dysarthria. He had hurt 7 days
before the administration. His course got worse complicating trismus, spasms, and
respiratory failure. He was transferred to our intensive care unit. On examination, his
blood pressure was 216/138 mmHg, heart rate was 110/min. He showed muscle rigidity
in his arms and legs. With the diagnosis of tetanus, penicillin G was started.
Rocuronium, propofol, and fentanyl were used for controlling spasms. His respiratory
failure required mechanical ventilation. His blood pressure was labile showing extreme
hypotension, and that resulted in the cessation of intermittent hemodialysis. Continuous
hemodiafiltration was initiated, however the blood pressure remained labile.
Intravenous

injection of magnesium-sulfate targeting

the serum magnesium

concentration of 2-3 mmol/L succeeded in stabilizing his hemodynamics (Fig. 1).
Magnesium was continued for 2 weeks and renal replacement therapy could be switched
to intermittent HD.
Magnesium has been shown to be effective in reducing spasms and autonomic

This article is protected by copyright. All rights reserved.

Accepted Article

instability (2). Intravenous infusion of magnesium targeting the concentrations of 2-4
mmol/L is recommended from a randomized controlled trial in patients without renal
impairment (1). Hypermagnesemia causes nausea and headache at the concentration of
2-3 mmol/L, and hypotension, muscle paralysis and coma above the concentration of 3
mmol/L (3). Serum magnesium concentration in patients with ESRD tends to be high
and depends on dialysis clearance. It has recently been suggested that magnesium
supplementation targeting high normal range may be beneficial in reducing all-cause
and cardiovascular mortalities (4).
In patients with ESRD, serum magnesium concentration tends to be high and
depends on dialysis clearance (4). Our patient was successfully treated by monitoring
serum magnesium level. Magnesium can be a therapeutic option for tetanus even in
patients with ESRD.

References
1. Thwaites C, Yen L, Loan H, et al. Magnesium sulphate for treatment of severe
tetanus: a randomized controlled trial. Lancet 2006;368:1436-43.
2. Yen L, Thwaites C. Tetanus. Lance. 2019;393:1657-68.
3. Onishi S, Yoshino S. Cathartic-induced Fatal Hypermagnesemia in the Elderly.
Intern Med 2006;45:207-10.
4. Apetrii M, Covic A, Massy ZA. Magnesium supplementation: a consideration in
dialysis patients. Semin Dial 2018; 31: 11-14.

This article is protected by copyright. All rights reserved.

Accepted Article

Stabilized haemodynamics after injection of magnesium

This article is protected by copyright. All rights reserved. ...

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