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Mild to moderate symptoms typically appear when serum magnesium levels reach approximately 2.03.5 mmol/L and may include: Gastrointestinal effects : nausea, vomiting, abdominal cramping, and diarrhoea (often the first warning signs) Neuromuscular changes : muscle weakness, lethargy, and reduced reflexes Flushing and warmth : particularly in the face and extremities Hypotension : low blood pressure causing dizziness or light-headedness Severe symptoms emerge as magnesium levels continue to rise and can include: Loss of deep tendon reflexes : typically occurring at levels of 3.55 mmol/L Cardiac abnormalities : bradycardia (slow heart rate), arrhythmias, and ECG changes including prolonged PR interval and widened QRS complex Respiratory depression : slowed or shallow breathing at levels above approximately 5 mmol/L, which can progress to respiratory arrest [2] Profound hypotension : potentially leading to cardiovascular collapse Neurological impairment : confusion, drowsiness, and in extreme cases, coma Cardiac arrest : typically occurring at levels exceeding 6.57 mmol/L The progression of symptoms generally correlates with rising serum magnesium concentrations, though individual responses may vary