SUBJECT: OBSTETRICS & GYNAECOLOGICAL

NURSING

DRUG STUDY ON :-
Magnesium sulphate

SUBMITTED TO: SUBMITTED BY:

Professor (Mrs.) Vinitha Suresh Miss LALITA SHARMA

H.O.D. MSc NURSING 1ST YEAR

OBSTETRICS AND GYNAECOLOGY J.I.N.S.A.R.

J.I.N.S.A.R.
 MAGNESIUM SULPHATE

INTRODUCTION:-The use of magnesium sulphate (MgSO4) in obstetrics has consistently aroused

controversy depict many years of experience with its use. MgSO4 was first used to prevent eclamptic
seizures in 1906by Horn in Germany, who inject it intrathecally .an intramuscular regimen was used
in 1926 to prevent recurrent seizures in women with eclampsia and the drug was given intravenously
in 1933 to women with pre-eclampcia.

CLINICAL PHARMACOLOGY:-

 At high serum concentrations Mg is a potent vasodilator, muscle relaxant and sedative

 Magnesium is the second most common intracellular caution. One half of body Mg is in
bone, one-fourth is in muscle and one-fourth is in soft tissue. About 25% to 30% of total
plasma Mg is bound to protein, 10% to 15% circulates in complex form and 55% to 60% is
ionised.
 Readily crosses the placenta and is distributed in mothers milk, however breastfeeding is not
contraindicated. In the newborn Mg absorption occurs in the small intestine: 55% to 75% of
ingested Mg normally is absorbed. The main route of Mg loss is through the kidneys. Serum
magnesium concentrations are maintained within a narrow range. At the three major target
organs for hormonal control of Mg homeostasis (bone, intestine and kidney) the close inter-
relationship between Mg and Ca is evident.
 An elimination half life of 43.2 hours has been reported in newborn infants whose mothers
received magnesium sulphate. The elimination rate is the same for both preterm and term
infants.

ACTION:

Decreases acetylcholine in motor nerve terminals, which is responsible for anticonvulsant properties,
thereby reduce neuromuscular irritability. Ti also decreases intracranial edema and helps in dieresis.
Its peripheral vasodilation effect improves the uterine blood supply. Has depressant action on the
uterine muscle and CNS.

INDICATIONS

 Seizures refactory to other anticonvulsant therapy.

 Hypomagnesaemia.
 Severe persistent pulmonary hypertension of the newborn unresponsive to other vasodilation
management.

CONTRAINDICATIONS AND PRECAUTIONS

 Patients with heart block or myocardial damage.

  CAUTION in patients with impaired renal function and/or electrolyte imbalance.

DOSAGE AND ROUTE:-

 For control of seizures, 20 ml of 20 percent solution IV slowly in 3 to 4 minutes; to be

followed immediately by 10 ml of 50 percent solution IM, and continued 4 hourly till 24
hours postpartum.
 Repeat injections are given only if the knee jerks are present, urine output exceeds 100ml in
previous 4 hours and the respirations are more than 10/minute. The therapeutic level of serum
magnesium is 4 to 7 Meq/l.
 4 gm iv slowly over 10 min, followed by 2 gm/hr, and then 1 gm/hr in drip of 5 percent
dextrose for tocolytic effect.
 Currently there are three ways to deliver the magnesium sulphate,
1) High dose regimes like Pritchards,

2) Low dose regimes like Zuspan and

3) Single dose regime like VIMS regimes. Whatever the regimes is, delivering the drug
intravenously is the most preferred method and the duration of treatment should not normaly
exceed 24 hours.

HIGH DOSE REGIMENS LOW DOSE REGIMES SINGAL DOSE REGIME

LIKE PRITCHARDS LIKE ZUSPAN LIKE VIMS REGIMES
Loading dose Loading dose Loading dose
 4g IV,slow bolus (not 4g IV over 5-10 minutes IV MgSO4 4g, slow bolus
less than 3 minutes) Maintenance dose over 10-15 minutes to
followed by 5g IM in 1-2 g/hr, IV infusion. prevent cardiac arrest.
each buttock
 If convulsion persists Maintenance dose
over 15 minutes, 2g is IV 1g/hour MgSO4.
given over 2 minutes.
Maintenance dose
 5g IM every 4 hourly
at alternate sites. Play
particular attention to
knee reflex,
respiratory rate and
urine output.

1) The traditional Pritchard's Regime has been used for 55 years since 1955.The Pritchard's
regimes involves

Loading dose

 4g IV, slow bolus (not less than 3 minutes) followed by 5g IM in each buttock
  If convulsion persists over 15 minutes, 2g is given over 2 minutes.

Maintenance dose

 5g IM every 4 hourly at alternate sites. Play particular attention to knee reflex, respiratory
rate and urine output.

2) Zuspan Regime is given by

Loading dose

4g IV over 5-10 minutes

Maintenance dose

1-2 g/hr, IV infusion.

 Study shows than Zuspan's regime is eight times less effective than Pritchard's regime in the
prevention of convulsion in pre eclampsia and eclampsia. Maternal mortality was 2.5 times
greater in women who received Zuspan's regimen than among those on Pritchard's regimen.

 Even so, current study shows that seizure can be safely controlled in women with eclampsia
with a lower dose of MgSO4, with the advantage of a lower magnesium toxicity. It therefore
seems that a lower dose of MgSO4 can be safely used at peripheral institutions where
facilities for proper monitoring are lacking.

3) VIMS the low dose regime is used as follow,

Loading dose

IV MgSO4 4g, slow bolus over 10-15 minutes to prevent cardiac arrest.

Maintenance dose

IV 1g/hour MgSO4.

If convulsion persist after 15 minutes, a further 2g MgSo4 diluted in 6 ml normal saline or sterile
water is given over 15 minutes.
SIDE EFFECTS:-

Maternal:-

 ECG changes (prolongation of the atrio-ventricular conduction time, sinoatrial block and
atrio-ventricular block).
 Circulatory collapse, hypotension.
 Gastrointestinal disturbances (diarrhoea, abdominal distension, absence of bowel sounds).
 Urinary retention.
 CNS depression (central sedation, muscle relaxation, hyporeflexia and decreased
excitability).
 Calcium and potassium disturbances.
 Respiratory depression.
Fetal:-
 Tachycardia
 Hypoglycaemia.

SPECIAL CONSIDERATIONS

 Anticipate change in calcium and phosphorus balance.

 Drug interaction has been reported between magnesium sulphate and gentamicin (respiratory
arrest).
 Monitor serum magnesium and calcium levels.
 Antidote for hypermagnesaemia is calcium gluconate 10 percent 10 ml IV.

NURSING CONSIDERATIONS:-

Fetal assessment:-

Fetal Heart Rate:-120-160 beats/min

 Decreased signs of fetal distress are reported to the physician

ASSESS:-

 Vital signs after 15 min after IV dose. Do not exceed 150 mg/ min.
 Monitor magnesium levels.
 If using during labour time contractions, determine intensity.
 Urine output should remain 30 ml/hr or more, if less notify physician.
 Uterine contractions when used as tocolytic agents.
 Reflexes- knee jerk, patellar reflex.

ADMINISTER:-

 Only after calcium gluconate is available for treating magnesium toxicity.

  Using infusion pump and monitor carefully; IV at less than 150 mg/min; circulatory
collapse may occur
 Only dilutions.

PERFORM / PROVIDE

 Seizure precautions: place client in single room with decreased stimuli, padded side
rails.
 Positioning of client in left lateral recumbent position to decrease hypotension and
increase renal blood flow.

EVALUATE:-

 Mental status , sensorium, memory.

 Respiratory status; respiratory depression, rate and rhythm. Hold drug if respirations
are less than 12/min.
 Hypermagnesemia: depressed patellar reflex, flushing, confusion, weakness, flaccid
paralyasis, dyspnea
 Respiratory rate, rhythm and reflexes of newborn if drug was given within 24 hours
prior to delivery.
 Reflexes; knee jerk and patellar reflexes decrease with magnesium toxicity.
Discontinue infusion if respirations are below 12/min, reflexes severely hypotonic,
urine output below 30ml/hr or in the event of mental confusion or lethargy or fetal
distress.

TEACH CLIENT AND FAMILY:-

 One all aspects of the drug: action, side effects and symptoms of hypermagnesemia.
 To remain in bed during infusion.
 CONCLUSION

 Magnesium sulphate has been used in the treatment of eclampcia in north America for many
year. There is no consensus as to the dosing regimen , but care should be taken to avoid
magnesium toxicity.
 BIBLIOGRAPHY

 Jacob Annamma, , A Comprehensive Textbook Of Midwifery And Gynecological Nursing,

3rd Edition 2012, Page No.614 615
 Dutta’s D.C., Textbook Of Obstetrics, Seventh Edition, Edited By Hiralal Konar ,Page
No234,508
 www. Drugs.com/../magnesium sulphate.
 www, m. Webmd.com/../magnesium sulphate.