A Drug Study on

MAGNESIUM SULFATE

In Partial Fulfillment of the Requirements in

NCM 109 – RLE

Care of Mother, Child at Risk or With Problems

Submitted to:

Mr. Lendell Kelly B. Ytac, RN

Clinical Instructor

Submitted by:

Clint S. Ancog

BSN – 2A
Generic Name: Magnesium Sulfate

Brand Name: MgSO4

Drug Class: Antidysrhythmics, V.; Electrolytes

What is Magnesium Sulfate?

Magnesium sulfate is a naturally occurring mineral used

to control low blood levels of magnesium. Magnesium sulfate injection is also used
for pediatric acute nephritis and to prevent seizures in severe pre-
eclampsia, eclampsia, or toxemia of pregnancy.

Dose

 Hypomanesemia

Adult

Mild: 1 g intramuscularly (IM) every 6 hours for 4 doses

Severe: 5 g intravenously (IV) over 3 hours

Maintenance: 30-60 mg/kg/day IV

Pediatric

Intravenous/intramuscular (IV/IM): 25-50 mg/kg every 4-6 hours for 3-4 doses

as needed

Oral: 100-200 mg/kg every 6 hours

 Toxemia of Pregnancy

Indicated to prevent seizures associated with pre-eclampsia, and for control of

seizures with eclampsia

4-5 g (diluted in 250 mL NS/D5W) intravenously (IV) in combination with

either (a) up to 10 g (10 mL of undiluted 50% solution) divided and
administered intramuscularly (IM) into each buttock or (b) after initial IV dose,
1-3 g/ hour IV
  Torsades de Pointes

With pulse (ACLS): 1-2 g slow intravenous (IV) (diluted in 50-100 mL D5W)

over 5-60 minutes, then 0.5-1 g/ hour IV

Cardiac arrest (ACLS): 1-2 g slow IV (diluted in 10 mL D5W) over 5-20

minutes

 Acute Nephritis, Pediatric

100 mg/kg intramuscularly (IM) every 4-6 hours as needed or 20-40 mg/kg IM
as needed

Severe: 100-200 mg/kg intravenously (IV) as 1-3% solution; administer total

dose within 1 hour, one-half within first 15-20 minutes

 Preterm Labor (Off-label)

Used as a tocolytic to stop preterm labor

Loading dose: 4-6 g intravenously (IV) over 20 minutes; maintenance: 2-4

g/hour IV for 12-24 hours as tolerated after contractions cease

Do not exceed 5-7 days of continuous treatment; longer treatment duration

may lead to low blood calcium (hypocalcemia) in developing fetus resulting in
neonates with skeletal abnormalities related to osteopenia

 Bronchospasm, Pediatric (Off-label)

25-50 mg/kg intravenously (IV) over 10-20 minutes

Indications

 Mild magnesium deficiency

 Severe hypomagnesemia
 Constipation
 Indigestion
 Prevent control seizures in preeclampsia or eclampsia
 Acute nephritis
Contraindications

 Hypersensitivity
 Myocardial damage, diabetic coma, heart block
 Hypermagnesemia
 Hypercalcemia
 Administration during 2 hours preceding delivery for mothers with toxemia of
pregnancy

Side Effects

 Circulatory collapse
 Respiratory paralysis
 Low core body temperature (hypothermia)
 Excess fluid in the lungs (pulmonary edema)
 Depressed/poor reflexes
 Low blood pressure (hypotension)
 Flushing
 Drowsiness
 Depressed cardiac function/heart disturbances
 Increased sweating
 Low blood calcium (hypocalcemia)
 Low blood phosphates (hypophosphatemia)
 Low blood potassium (hyperkalemia)
 Visual changes
 Breathing difficulties
 Confusion
 Weakness
 Flushing (warmth, redness, or tingly feeling)
 Feeling like you might pass out
 Anxiety
 Cold feeling
 Extreme drowsiness
 Muscle tightness or contraction
 Headache

Adverse Side Effects

 CNS (with I.V. use) – confusion, decreased reflexes, dizziness, syncope,

sedation, hypothermia, paralysis
 CV (with I.V. use) – hypotension, arrhythmias, circulatory collapse
 GI – nauseas, vomiting, cramps, flatulence, anorexia
 Metabolic – Hypermagnesemia, hypocalcemia
 Musculoskeletal (with I.V use) – muscle weakness, flaccidity
  Respiratory – respiratory paralysis
 Skin – diaphoresis
 Other – allergic reaction, injection site reaction, laxative dependence (with
repeated or prolonged use)

Drug Interaction

 demeclocycline
 doxycycline
 eltrombopag
 lymecycline
 minocycline
 oxytetracycline
 tetracycline

Nurse Responsibilities

1. Assess the patellar reflex and check for a respiratory rate of 16 breaths per
minute or more while giving prolonged or repeated I.V. infusions.
2. Track blood magnesium levels when using an IV (the optimal range is 3 to 6
mg/dl or 2.5 to 5 mEq/L). Make a mental note of any signs and symptoms of
magnesium toxicity (hypotension, nausea, vomiting, ECG changes, muscle
weakness, mental or respiratory depression, and coma). To avoid magnesium
toxicity, keep injectable calcium on hand.
3. Every four hours, check urine production, which should be at least 100 ml.
4. Assess the neonate for signs and symptoms of magnesium toxicity, such as
neuromuscular or respiratory depression, if I.V. magnesium was given before
delivery.
5. Monitor electrolyte levels and liver function tests.
6. Instruct the patient about how to deal with negative reactions. Instruct him to
mention any symptoms he experiences when receiving an IV.
7. If the patient is taking some other medications, advise him to consult his
doctor before taking magnesium. Some drugs' absorption can be slowed or
accelerated by magnesium.
 8. Remind the client that taking magnesium citrate, hydroxide, or sulfate for an
extended period of time can cause laxative dependence. Inform him that a
balanced diet and regular exercise will help him avoid the use of laxatives.
9. Tell a pregnant woman to make sure her prescriber is aware of her pregnancy
before taking the medication.
10. As appropriate, review all other significant and life-threatening adverse
reactions and interactions, especially those related to the drugs and tests
mentioned above.

References

Cunha J. (n.d). Magnesium Sulfate. Retrieved from: https://www.rxlist.com/consumer

_magnesium_sulfate_mgso4/drugs-condition.htm