Hyperm agnesemia

Immediate Questions
A. What dose of magnesium sulfate was the patient receiving? Most patients receive 1-2 MgSO4 IV every hour. This dose is regulated by following serum levels and changes in physical examination such as decreased patellar reflexes, which are suggestive of high serum magnesium levels. Magnesium sulfate used in patients with premature labor may require doses of up to 3g/h.

Immediate Questions
B. What was her last serum magnesium level? Clinically significant hypermagnesemia can begin to be seen at levels as low as 4 mEq/L. Most patients who are being maintained on magnesium sulfate for the prevention of eclampsia will be held at 4-6 mEq/L.

Management
1. Magnesium. Toxicity may be seen at levels as low as 4 meq/l. Most patients are maintained at 4-6 meq/l to prevent eclampsia. Respiratory depression can appear at magnesium levels of 8-10 meq/l, and cardiotoxicity, while not usually seen until levels exceed 10 meq/l, can occur at any serum magnesium level. 2. Electrocardiogram. Obtain a baseline study. Hypermagnesemia may manifest itself as a shortened Q-T interval up

Management
3. Calcium gluconate. Administer 1 g IV over approximately one minute, while waiting for serum magnesium and electrolyte values. If calcium administration improves the patient's status, then magnesium toxicity is most likely the correct diagnosis: magnesium is a calcium antagonist, and calcium should reverse its toxicity. 4. Urine output. Magnesium is secreted by the kidneys. Urine output should be maintained at a minimum of 30 mL/h.