Acute hypomagnesaemia causing intra‐operative lower limb movements in a paraplegic patient, despite full neuromuscular blockade
Bibliographic record
Abstract
Alterations in electrolyte homeostasis associated with major surgery, intravenous fluid therapy, malnutrition, and critical illness are common but usually non-specific. This case report describes the sudden onset of forceful rhythmic flexion movements in both lower limbs during scoliosis surgery in a 12-year-old paraplegic boy with spina bifida. These movements arose despite adequate depth of anaesthesia, complete neuromuscular blockade, and treatment of hypocalcaemia. They persisted post-operatively after reversal of neuromuscular blockade and emergence from anaesthesia. Hypomagnesaemia was identified and treated post-operatively which coincided with cessation of the movements. We deduce hypomagnesaemia to be the aetiology of this unusual clinical presentation. This report underscores the interdependency of Ca2+ and Mg2+ homeostasis in excitable tissues and emphasizes that abnormalities observed in each cation should not be considered independently. In the perioperative care of spinal fusion patients, hypocalcaemia is a well-recognised and understood complication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".