First Mouthwash BLM and Renal dysfunction

Lidocaine topical is absorbed through intact skin and mucosal membranes. Prolonged exposure, large doses, and/or application to compromised skin or mucosa can result in elevated plasma concentrations of lidocaine. Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine topical should be administered cautiously and dosing modified for repeated doses in patients with compromised renal function.

Magnesium is eliminated by the kidney. The serum concentration of magnesium is increased in patients with renal impairment. Magnesium toxicity includes CNS depression, muscular paralysis, respiratory depression, hypotension and prolonged cardiac conduction time. Disappearance of the patellar reflex is a useful clinical sign of magnesium intoxication. Therapy with magnesium should be administered cautiously and dosages should be modified in patients with compromised renal function. Clinical monitoring of serum magnesium levels is recommended.