一位慢性腎臟病病人的血鎂為 3.2 mEq/L。哪項評估結果最重要且需回報給醫療提供者？
A client with chronic kidney disease (CKD) has a serum magnesium level of 3.2 mEq/L. Which assessment finding is most important to report to the provider?
- ADiminished deep tendon reflexes✓ 正解深腱反射減弱
- BIncreased thirst口渴增加
- CDiarrhea腹瀉
- DHyperactive bowel sounds腸鳴音亢進
血鎂正常值約為 1.3-2.1 mEq/L。此病人血鎂 3.2 mEq/L 屬於高血鎂症（Hypermagnesemia），常見於慢性腎臟病（CKD）病人，因腎功能衰竭無法有效排出鎂離子。鎂離子具有中樞神經抑制與神經肌肉阻斷的作用。高血鎂最嚴重的臨床表現是深腱反射（DTR）減弱或消失，這通常是呼吸抑制與心臟傳導阻滯的前兆。臨床思路上，護理師應優先評估病人的神經肌肉與呼吸狀態（Safety/ABC），若發現反射減弱，應立即通報並準備葡萄糖酸鈣（Calcium gluconate）作為拮抗劑。
The normal serum magnesium range is approximately 1.3-2.1 mEq/L. This client's serum magnesium of 3.2 mEq/L represents hypermagnesemia, which is commonly seen in clients with chronic kidney disease (CKD) due to impaired renal excretion of magnesium. Magnesium has central nervous system depressant and neuromuscular blocking effects. The most serious clinical manifestation of hypermagnesemia is diminished or absent deep tendon reflexes (DTR), which often precedes respiratory depression and cardiac conduction block. Clinically, the nurse should prioritize assessment of neuromuscular and respiratory status (safety/ABC); if reflexes are diminished, the provider should be notified immediately and calcium gluconate should be prepared as an antagonist.
台灣檢驗報告有時使用 mg/dL，而 NCLEX 統一使用 mEq/L。換算公式需注意，但在考試中記住 1.3-2.1 mEq/L 這個區間至關重要。美國臨床對於高血鎂的處理非常強調「心律監測」與「緊急給予鈣劑」。