Magnesium Sulfate

Indications:

• Torsades de pointes (antiarrhythmic of choice)
• Bronchospasm in asthma or COPD that is not responsive to other therapy

Contraindications:

• Shock or systolic blood pressure less than 110mmHg (adult) or 
    (70 mm Hg + (2 x age in years) )(pediatric)
• Heart block
• Respiratory depressionChronic kidney disease/dialysis

Precautions:

Inform BioTel prior to administration if:

• Hypomagnesemia is suspected
• Patient is on digitalis preparations
• Continuously monitor Vital Signs, ECG, SpO2, LOC and muscle strength

Side Effects:

• Diaphoresis
• Facial flushing
• Hypotension
• Depressed reflexes
• Hypothermia
• Bradycardia
• Circulatory collapse
• Respiratory depression
• Muscle weakness/paralysis
• CNS depression

Adult Dose:

Mix 2 grams of magnesium sulfate into a 250 mL bag of Normal Saline and infuse piggyback via microdrip tubing:

• Standing order, wide open:
  • Pulseless Torsades de Pointes (cardiac arrest)
• Standing order, over 20 minutes:
  • Perfusing Torsades de Pointes with pulse after successful cardioversion
• Standing order, over 20 minutes:
  • Refractory bronchospasm (BioTel authorization required if dialysis patient)
• Standing order, over 20 minutes:
  • Eclamptic seizure refractory to diazepam or midazolam, over 20 minutes

Pediatric Dose:

BIOTEL CONSULTATION FOR DOSE CONFIRMATION REQUIRED
Impending Respiratory Failure (altered mental status, severe ventilatory difficulty) in a pediatric patient over 2 years old or any age with asthma history:
Mix 2 grams of magnesium sulfate into a 250 mL bag of Normal Saline, and

• Administer 40 mg/kg (5 mL/kg) IV/IO infusion over 30 minutes.
• Maximum dose: 2 g.

Administer simultaneously with 1:1000 epinephrine 0.01 mg/kg IM (0.01 mL/kg)  (Maximum dose: 0.3 mg (0.3 mL))

Route: IV or IO piggyback

Drug Action:

• Reverses magnesium deficiency
• Blocks calcium channels
• Increases intracellular potassium
• Depresses the Central Nervous System
• Relaxes smooth muscle

Class:

• Electrolyte
• Anticonvulsant
• Smooth Muscle Relaxant

Onset: Immediate following IV infusion

Duration: 30 minutes

Antidote: Calcium Chloride