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Name /bks_53161_deglins_md_disk/magnesiumsulfateivparent 1 02/17/2014 07:15AM High Alert magnesium sulfate (IV, parenteral) (9.9% Mg; 8.1 mEq Mg/g) (mag-nee-zhum sul-fate) Classification Therapeutic: mineral and electrolyte replacements/supplements Pharmacologic: minerals/electrolytes Pregnancy Category D Plate # 0-Composite pg 1 # 1 and bone changes in newborn); avoid continuous use during active labor or within 2 hr of delivery due to potential for magnesium toxicity in newborn. Use Cautiously in: Any degree of renal insufficiency; Geri: May requirepdosage due to age-relatedpin renal function. Adverse Reactions/Side Effects CNS: drowsiness. Resp:prespiratory rate. CV: arrhythmias, bradycardia, hypotension. GI: diarrhea. MS: muscle weakness. Derm: flushing, sweating. Metab: hypothermia. Indications Interactions Drug-Drug: May potentiate calcium channel blockers and neuromuscular Treatment/prevention of hypomagnesemia. Treatment of hypertension. Prevention of seizures associated with severe eclampsia, pre-eclampsia, or acute nephritis. Unlabeled Use: Preterm labor. Treatment of torsade de pointes. Adjunctive treatment for bronchodilation in moderate to severe acute asthma. Route/Dosage Treatment of Deficiency (Expressed as mg of Magnesium) Action Essential for the activity of many enzymes. Plays an important role in neurotransmission and muscular excitability. Therapeutic Effects: Replacement in deficiency states. Resolution of eclampsia. Pharmacokinetics Absorption: IV administration results in complete bioavailability; well absorbed from IM sites. Distribution: Widely distributed. Crosses the placenta and is present in breast milk. Seizures/Hypertension IM, IV (Adults): 1 g q 6 hr for 4 doses as needed. IM, IV (Children): 20– 100 mg/kg/dose q 4– 6 hr as needed, may use up to 200 mg/kg/dose in severe cases. IV (Infants and Children): 25– 50 mg/kg/dose, maximum dose: 2 g. Bronchodilation TIME/ACTION PROFILE (anticonvulsant effect) ROUTE ONSET PEAK DURATION IM IV 60 min immediate unknown unknown 3–4 hr 30 min IV (Adults): 2 g single dose. IV (Children): 25 mg/kg/dose, maximum dose: 2 g. Eclampsia/Pre-Eclampsia Contraindications/Precautions Contraindicated in: Hypermagnesemia; Hypocalcemia; Anuria; Heart block; OB: Avoid using for more than 5– 7 days for preterm labor (mayqrisk of hypocalcemia ⫽ Genetic Implication. IM, IV (Adults): Severe deficiency— 8– 12 g/day in divided doses; mild deficiency— 1 g q 6 hr for 4 doses or 250 mg/kg over 4 hr. IM, IV (Children ⬎ 1 mo): 25– 50 mg/kg/dose q 4– 6 hr for 3– 4 doses, maximum single dose: 2 g. IV (Neonates): 25– 50 mg/kg/dose q 8– 12 hr for 2– 3 doses. Torsade de Pointes Metabolism and Excretion: Excreted primarily by the kidneys. Half-life: Unknown. ⫽ Canadian drug name. blocking agents. IV, IM (Adults): 4– 5 g by IV infusion, concurrently with up to 5 g IM in each buttock; then 4– 5 g IM q 4 hr or 4 g by IV infusion followed by 1– 2 g/hr continuous infusion (not to exceed 40 g/day or 20 g/48 hr in the presence of severe renal insufficiency). CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued. PDF Page #1 Name /bks_53161_deglins_md_disk/magnesiumsulfateivparent 02/17/2014 07:15AM Part of Parenteral Nutrition IV (Adults): 4– 24 mEq/day. IV (Children): 0.25– 0.5 mEq/kg/day. NURSING IMPLICATIONS Assessment ● Hypomagnesemia/Anticonvulsant: Monitor pulse, BP, respirations, and ECG ● ● ● pg 2 # 2 ● Continuous Infusion: Diluent: Dilute in D5W, 0.9% NaCl, or LR. Concentra- 2 ● Plate # 0-Composite frequently throughout administration of parenteral magnesium sulfate. Respirations should be at least 16/min before each dose. Monitor neurologic status before and throughout therapy. Institute seizure precautions. Patellar reflex (knee jerk) should be tested before each parenteral dose of magnesium sulfate. If response is absent, no additional doses should be administered until positive response is obtained. Monitor newborn for hypotension, hyporeflexia, and respiratory depression if mother has received magnesium sulfate. Monitor intake and output ratios. Urine output should be maintained at a level of at least 100 mL/4 hr. Lab Test Considerations: Monitor serum magnesium levels and renal function periodically throughout administration of parenteral magnesium sulfate. Potential Nursing Diagnoses Risk for injury (Indications) (Side Effects) Implementation ● High Alert: Accidental overdosage of IV magnesium has resulted in serious pa- tient harm and death. Have second practitioner independently double check original order, dose calculations, and infusion pump settings. Do not confuse milligram (mg), gram (g), or millequivalent (mEq) dosages. ● IM: Administer deep IM into gluteal sites. Administer subsequent injections in alternate sides. Dilute to a concentration of 200 mg/mL prior to injection. IV Administration ● Direct IV: Diluent: 50% solution must be diluted in 0.9% NaCl or D5W to a concentration of ⱕ20% prior to administration. Concentration: ⱕ20%. Rate: Administer at a rate not to exceed 150 mg/min. tion: 0.5 mEq/mL (60 mg/mL) (may use maximum concentration of 1.6 mEq/ mL (200 mg/mL) in fluid-restricted patients). Rate: Infuse over 2-4 hr. Do not exceed a rate of 1 mEq/kg/hr (125 mg/kg/hr). When rapid infusions are needed (severe asthma or torsade de pointes) may infuse over 10– 20 min. ● Y-Site Compatibility: acyclovir, aldesleukin, alemtuzumab, alfentanil, amifostine, amikacin, argatroban, ascorbic acid, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, caspofungin, cefotaxime, cefoxitin, ceftazidime, chloramphenicol, chlorpromazine, cisatracurium, cisplatin, clindamycin, clonidine, cyanocobalamin, cyclophosphamide, cytarabine, dactinomycin, daptomycin, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin liposome, doxycycline, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, labetalol, leucovorin caclium, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, methotrexate, methyldopate, metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone, mitoxantrone, morphine, moxifloxacin, multivitamins, mycophenolate, nafcillin, nalbuphine, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, pemetrexed, penicillin G, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, propofol, propranolol, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid. ● Y-Site Incompatibility: aminophylline, amphotericin B cholesteryl sulfate, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, azathio䉷 2015 F.A. Davis Company CONTINUED PDF Page #2 Name /bks_53161_deglins_md_disk/magnesiumsulfateivparent 02/17/2014 07:15AM Plate # 0-Composite pg 3 # 3 3 PDF Page #3 CONTINUED magnesium sulfate (IV, parenteral) prine, calcium chloride, cefepime, ceftriaxone, cefuroxime, ciprofloxacin, dantrolene, dexamethasone sodium phosphate, diazepam, diazoxide, doxorubicin hydrochloride, epirubicin, ganciclovir, haloperidol, indomethacin, methylprednisolone sodium succinate, pentamidine, phenytoin, phytonadione. Patient/Family Teaching ● Explain purpose of medication to patient and family. Evaluation/Desired Outcomes ● Normal serum magnesium concentrations. ● Control of seizures associated with toxemias of pregnancy. Why was this drug prescribed for your patient? ⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.