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Magnesium Sulfate

Electrolyte

ACP: Treatment of Torsades de Pointes

ACP: Bronchospasm refractory to bronchodilation in acute asthma exacerbation

ACP: Management of seizures in pregnancy associated with hypertension

Contraindication

  • Hypersensitivity to magnesium sulfate
  • Second or third-degree AV block

Caution 

  • Hypotension
  • Concurrent use of neuromuscular blockade
  • Myasthensia gravis

ACP: Torsades de Pointes/Polymorphic VT Refer to WCT

  • For perfusing rhythms (stable): 2 g IV over 15 minutes 
  • In cardiac arrest: 2 g IV push over 1-2 minutes

ACP: Bronchospasm refractory to bronchodilation

  • 2 g IV over 15 minutes

ACP: Prophylaxis of seizures in pregnancy associated with hypertension. Refer to Preeclampsia

  • ☎️ CliniCall consultation required prior to administration to discuss treatment plan.
  • Cardiac monitoring is required
  • Administer 5 g intravenously over 15 minutes
  • Can give 5 g intramuscularly if unable to start IV (use bilateral buttocks) 

ACP: Prevention of recurrent seizures in pregnancy associated with hypertension. Refer to Eclampsia

  • Cardiac monitoring is required
  • Administer 5 g intravenously over 15 minutes followed by 1 g/hour
  • Can give 5 g intramuscularly if unable to start IV (use bilateral buttocks) followed by 5 g IM every 4 hours

If seizures persist greater than 5 minutes contact EPOS for further care options. 

Follow weight-based dosing

ACP: Torsades de Pointes/polymorphic VT

  • For perfusing rhythms(stable): 50 mg/kg IV/IO (maximm 2 g) over 15 minutes
  • In cardiac arrest 50 mg/kg IV/IO (maximum 2 g) IV push over 1-2 minutes

ACP: Bronchospasm

  • Severe asthma refractory to bronchodilator: 50 mg/kg IV/IO (maximum 2 g) over 15 minutes

 

Infusion
Adult and pediatric standard concentration

  • 2g in 50mL NS
  • 5g in 50mL NS

The precise mechanism of action of magnesium sulfate is not entirely clear.  It appears to alter membrane potential, slowing conduction and relaxing smooth muscle. 

Intravenous: 

  • Onset: 1-2 minutes
  • Peak: < 5 minutes
  • Duration: 30 minutes as anticonvulsant

Infusions may take up to 20-30 minutes to produce significant bronchodilation

  • Hypotension
  • Heart block
  • Drowsiness
  • Respiratory depression
  • Arrhythmias

 

Calcium chloride should be available for magnesium sulphate overdose. 

May prolong the effects of non-depolarizing neuromuscular blockers and may potentiate the effects of calcium channel blockers.

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