Which treatment is used to counteract hypermagnesemia?

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When magnesium levels are too high, the immediate danger comes from its depressant effect on nerves and the heart. The best way to counter this is to protect the heart and stabilize membrane excitability, which is achieved with IV calcium gluconate. Calcium gluconate counteracts magnesium’s effects on cardiac myocytes by increasing the threshold for depolarization, helping prevent dangerous bradycardia and conduction problems. It doesn’t remove magnesium from the body by itself, but it buys critical time for the body to excrete the excess magnesium.

After stabilization, the goal is to reduce magnesium levels, typically by stopping magnesium-containing substances and promoting excretion (fluids and possibly diuretics if kidney function is adequate). In severe cases or with kidney failure, dialysis may be necessary. The other options would not provide the immediate cardioprotective effect and could actually worsen the situation.