- Magnesium replacement
- Treatment of seizures and encephalopathy associated with acute nephritis
- Treatment of hypertension
- Treatment and prevention of Torsade de Pointes
- Adjunctive treatment for bronchodilation in moderate to severe asthma (unlabeled use)
- Treatment of chronic pain/migraine
- Hypomagnesemia during a code transfusion (massive hemorrhage)
-
Prepared SYRINGE of magnesium sulfate 40 mg/mL
-
Prepared IV BAGS for infusion: 2 to 4 mmol Magnesium sulfate/L ( equals 500 to 1000 mg Magnesium/L)
- Solutions Compatible: dextrose solutions,0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate
- Additives/Above Cassette Compatible: KCl
- Y-site Compatible: cefazolin, cefotaxime, dobutamine, heparin, KCl, morphine, TPN (amino acids/dextrose), vancomycin
- Incompatible: furosemide
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
|
NO |
| IM |
NO |
|
IV Intermittent MDU for chronic pain |
YES SYRINGE PUMP - respiratory and cardiac monitoring Infusion rate: do not exceed 150 mg magnesium sulfate/minute |
| IV Intermittent Infusion - Pediatric Units |
YES SYRINGE PUMP - respiratory and cardiac monitoring Infusion time: 1- 4 hours |
| IV Continuous Infusion |
YES - SYRINGE PUMP Usual Dilution: 0.16 mmol/mL (magnesium sulfate 40 mg/mL) Infusion time: Max rate of 0.25 mL/kg/hour YES - LARGE VOLUME PUMP in Oncology Usual Dilution: 2 to 4 mmol magnesium /L of IV solution |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
PEDIATRIC:
-Management of seizures:
Use prepared SYRINGE of magnesium sulfate 40 mg/mL
Dose: 20 to 100 mg magnesium sulfate /kg/dose IV Q4-6H PRN
May use up to 200 mg magnesium sulfate/kg/dose
-Broncholidation, as adjunctive therapy
Use prepared SYRINGE of magnesium sulfate 40 mg/mL
Dose: 25 to 50 mg magnesium sulfate /kg/dose IV x 1 dose
Maximum single dose: 2000 mg magnesium sulfate
A few reports in literature describe administration of a second dose in 4 - 6 hours if clinically necessary
- Hypomagnesemia in PICU
Use prepared SYRINGE of magnesium sulfate 40 mg/mL
Dose: 25 to 50 mg/kg/dose IV Q4-6H x 3-4 doses
Higher doses up to 100 mg/kg/dose have been used
Maximum single dose: 2000 mg magnesium sulfate
- Prevention of torsade de pointes, for QTc > 500ms:
Use prepared SYRINGE of magnesium sulfate 40 mg/mL
Dose: 25 to 50 mg/kg/dose IV x 1 dose
Maximum single dose: 2000 mg magnesium sulfate
- Replacement for hypomagnesemia:
Dose: 10 mg/kg/hour IV (MAX 500 mg/hr) x 4 hours (then reassess)
-Prevention/Treatment of cisplatin-induced hypomagnesemia in Oncology:
Use IV solution prepared by Pharmacy (2 to 4 mmol Magnesium/L of IV solution)
-Hyperkalemia during a code transfusion (massive hemorrhage)
- 25-50mg/kg over 20 minutes (max: 2 grams)
- Followed by infusion of 15 mg/kg/hr target of serum Mg > 1.5 mmol/mL
- If serum Mg >2.0 mmol/mL, reduce infusion by 50%
ADULT:
- Hypomagnesemia:
- 1000 mg magnesium sulfate IM/IV Q 6 hours x 4 doses
- Maximum single dose: 2000 mg magnesium sulfate
- Management of seizures: 1000 mg magnesium sulfate IM/IV Q 6 hours PRN
- Bronchodilation: 2000 mg magnesium sulfate as a single dose
- Adverse effects are often related to the magnesium serum levels:
- CNS depression
- Hypotension
- Muscle weakness
- Flushing of skin, somnolence, sweating
- Depressed deep tendon reflexes (patellar reflex) at magnesium serum concentrations > 10 mmol/L and absent at 20 mmol/L
- Respiratory depression and complete heart block may occur at magnesium levels greater than 20 mmol/L
- NOTE: magnesium toxicity is exacerbated by hypocalcemia
- Monitor urine output. During infusion, monitor for cardiac dysrhythmias, hypotension, respiratory and CNS depression
- Serum magnesium levels recommended if dosing is prolonged, continuous infusion is employed or in patients with renal failure
- Hypomagnesemia may contribute to the development of digoxin toxicity. However, supplementation with magnesium should be carried out slowly (over several days) because magnesium re-equilibrates slowly and because hypermagnesemia may cause arrhythmias and alter cardiac conduction, leading to heart block
- Contraindicated in: heart block, serious renal impairment
- Antidote for respiratory depression is calcium chloride or calcium gluconate
- IV onset: immediate (as an anticonvulsant)
- IV duration: 30 minutes (as an anticonvulsant)