GENERAL SANTOS DOCTORS' MEDICAL SCHOOL FOUNDATION INC.

NCM107n RLE EXPOSURE

Area: OB ward Inclusive Dates: October 14, 2021

Patient: No data Attending Physician: *Students Name: Borling

Age and Sex: No data Diagnosis: Year and Section: BSN2 - B
Chief Complaints: No data Group: N/A

INDICATION, CONTRAINDICATION
CLASSIFICATI MECHANISM
& ADVERSE REACTIONS NURSING RESPONSIBILITIES
ON OF ACTION
DRUG (Brand name and Generic name) DOSAGE (Recommended and Actual)
Generic Name:  Minerals & Replaces In severe renal impairment, reduce dosage CNS: Nursing Considerations:
Magnesium sulfate Electrolyte magnesium and and obtain frequent serum magnesium  Toxicity
replacement maintains levels.  Weak or absent deep  Keep IV calcium available to
Brand Names: magnesium level; tendon reflexes reverse magnesium intoxication.
Epsom Salt, Sulfamag, MgSO4 Comerford, K. as an  Mild hypomagnesemia –  Paralysis  Test knee-jerk and patellar
https://www.drugs.com/ingredient/magnesium- C., & Durkin, M. anticonvulsant, Adults: 1g IM every 6 hours for 4  Drowsiness reflexes before each additional
sulfate.html T. (2021). reduces muscle doses depending on magnesium level  Stupor dose. If absent, notify prescriber
Nursing 2021 contractions by  Symptomatic severe and give no more magnesium
drug handbook. interfering with hypomagnesemia with magnesium CV: until reflexes return; otherwise,
Pregnancy Category: 41st edition. release of level of 0.8 mEq/L or less –  Slow, weak pulse patient may develop temporary
Philadelphia: acetylcholine at Adults: 5g IV in one liter of D5W or  Arrhythmias respiratory failure and need
Magnesium sulfate is under pregnancy Wolters Kluwer. myoneural NSS over 3 hours. Based on  Hypotension cardiopulmonary resuscitation or
category D. There is positive evidence of conjunction. subsequent doses on magnesium level.  Circulatory collapse IV administration of Calcium.
human fetal risk based on adverse reaction data  Magnesium supplementation in  Flushing  Check magnesium level after
from investigational or marketing experience Comerford, K. C., total parenteral nutrition (TPN) – repeated doses. Monitor levels
or studies in humans, but potential benefits & Durkin, M. T. Adults: 8-24 mEq IVdaily added to GI: hourly in patients with severe
may warrant use of the drug in pregnant (2021). Nursing TPN solution.  Diarrhea hypomagnesemia. Normal plasma
women despite potential risks, according to the 2021 drug Infants: 2-10 mEq / day IV added to magnesium level is 1.5 – 2.5
US FDA pregnancy category D. handbook. 41st TPN solution Metabolic: mEq/L.
https://www.drugs.com/pregnancy/magnesium- edition.  Seizures in preecmlapsia or  Hypocalcemia  Monitor fluid intake and output.
sulfate.html Philadelphia: eclampsia – Output should be 100ml or more
Wolters Kluwer. Adults: total initial dose is 10-14g IV. Respiratory: during 4-hour period before dose.
To accomplish this, give 4-5g IV in  Respiratory distress  Monitor renal function
250ml of solution and simultaneously  Drug may contain aluminum.
give up to 10g IM (5g or 10ml of Skin: Premature neonates are at high
undiluted 50% solution in each  Diaphoresis risk for aluminum toxicity due to
 bottle). After initial IV dose, some
clinicians administer 1-2g/hr by
constant IV infusion. Base subsequent
doses on magnesium level; serum
magnesium level of 6mg/100ml is
considered optimal for seizure control.
Don’t exceed 40g in a 24 hrs period.
Maximum dose in patients with severe
renal insufficiency is 20g/48 hrs.
Contraindications:
 Contraindicated in patients with
myocardial damage, heart block, or
coma.
 Use cautiously in patient with
impaired renal function.
 When drug is administered by
continuous IV infusion ( specially for
more than 24 hours preceding
delivery) to control seizure in a
toxemic woman, neonate may show
signs of magnesium toxicity,
including neuromuscular or
respiratory depression.
 Use cautiously and monitor closely in
pregnant women in active labor, in
pregnant women with preeclampsia or
eclampsia who are at risk for seizures,
and in pregnant women at risk for
preterm delivery.
 Drug appears in human milk. Use
cautiously in breastfeed women.
Comerford, K. C., & Durkin, M. T. (2021).
Nursing 2021 drug handbook. 41st edition.
Philadelphia: Wolters Kluwer.
Pregnancy & Breastfeeding warnings:
 Intravenous use for more than 5 to 7
Other:
 Hypothermia
Comerford, K. C., & Durkin, M.
T. (2021). Nursing 2021 drug
handbook. 41st edition.
Philadelphia: Wolters Kluwer.
immature renal function.
Aluminum exposure of more than
4-5mcg/kg/day is associated with
CNS and bone toxicity.
 Patients with prolonged exposure
to magnesium sulfate who have
impaired renal function are at risk
for aluminum toxicity.
 Look alike-sound alike: Don't
confuse magnesium sulfate with
manganese sulfate.
Patient Teaching:
 Explain use and administration of
drug to patient and family.
 Emphasize importance of keeping
lab appointments.
 Tell patient about warning signs
of high or low magnesium level.
Encourage patient to report all
adverse effects.
Comerford, K. C., & Durkin, M. T.
(2021). Nursing 2021 drug handbook.
41st edition. Philadelphia: Wolters
Kluwer.
 Inform women that the efficacy
and safety of this medication for
preterm labor have not been
established, and that using it for
more than 5 to 7 days can result in
fetal abnormalities.
 Avoid using it in the two hours
before delivery unless it is the
only treatment option for
eclamptic seizures.
 Observe the fetal heart rate.
https://www.drugs.com/pregnancy/ma
gnesium-sulfate.html

days can result in fetal abnormalities.
 Use by obstetrical personnel in a
hospital with appropriate obstetrical
care facilities for preterm labor.
https://www.drugs.com/pregnancy/magnes
ium-sulfate.html
 Instruct the patient that she can
get natural sources of magnesium
to dark chocolate, avocados, nuts,
seeds, some fatty fishes, legumes,
tofu, whole grains, bananas, and
leafy greens.
https://www.healthline.com/nutrition/1
0-foods-high-in-
magnesium#TOC_TITLE_HDR_11