16 replies to this topic

[Captain ToHellWithItAll]

I apologize, I actually thought this would be easy. We already give it, I was simply tasked with finding out what other people are doing and to see how we compare.

I was anticipating a minute to complete the survey and a couple of minutes to cut and past from their protocols, I was specifically trying to avoid a lengthy discussion that might get off topic.



Please feel free to send a link.

Croaker, I'll bet that most people on this site would have to go look up their protocols because mag isn't a drug routinely given. I can count on one hand how many times I've given it and I think I'd have at least one finger left over.

[DwayneEMTP]

The vast majority of my experience using mag has been with severe refractory asthma, state protocol calls for 1-2 Gms IVP over 5 minutes, which sounds completely wrong to me and most others (MD's included). In my typical adult patient I routinely place 2 Gms in 100 ml of NS or D5 w/a 10gtt set and infuse it over 10 minutes, which is still about twice as fast as recommended by most sources I've read.

That is my experience as well.

When I was doing my OB clinicals in school twice I was witness to patiens with ecalampsia/pre eclampsia. The first the patient had begun to seize, the Doc came in and pushed 7mg of Mag over, maybe 30 seconds. I just sat there and waited for her to crump, when in fact, over just a few minutes she was fine. The preeclampsia patient was the same, same dose, same delivery, and again, no adverse effects that I could see.

Like most of us I'm guessing, they scared the hell out of me in regards to pushing too much/to fast with Mag, but in these two cases at least that proved to be untrue. I'd asked him about it later and he said that we all freak out about it too much, that 7mg IVSP/2 mins is pretty standard treatment for him.

I mentioned this to the physician instructor, 25 year ER doc from Denver General, that we had at our school and she said that she'd commonly seen it done though would never feel comfortable doing it herself...So...

It's a mystery....Maybe one of our brainiacs can spell it out for us? Docs, Chbare??

Dwayne

[systemet]

I've actually never read the research on mag. I should maybe go and look it up.

My anecdotal experience has been seeing the results of giving it too fast a couple of times (I know, once is too many times). We typically gave it over 8-10 minutes, but in both these cases they received it in a little closer to 2'. I should mention this was only a 2g dose for asthma. Both patients became quite flushed, and quite nauseous. One complained of "feeling like [their] skin [was] on fire". Neither vomiting, although they both seemed close, and while both had downward trends in their blood pressure immediately afterwards, neither became < 100mmHg systolic.

Honestly, I feel that I was lucky in both situations that it wasn't worse. This was given in a 50ml bag with a secondary set on a primary line. Regarding croaker's original post, I wonder if there's a possibility to get magnesium in a 2g preparation? We used to draw out of (I think) 5 g / 10 ml, and this seemed to run a bit of a risk of drawing up too much.

The major risks here are hypotension, and.... hypermangesemia. http://emedicine.med...766604-overview

While hypermagnesemia might not sound that bad, at high enough levels you can get cardiotoxicity, e.g. bradycardia, AV block, and you can also see inhibition of presynaptic ACh release, causing flaccid paralysis and apnea.

Looking around, I found that giving 2g of Mag over 20mins, usually equates to approximately a doubling in the normal serum concentration or 1.3-2.1 mEq/L. Typically events like paralysis and heart block occur at somewhat higher concentrations (one sources suggested 10 MEq/L for paralysis).

Where this might be a very big problem, however, is if the patient has renal failure. But in that case, we probably won't be giving magnesium in the first place.

If I find some time, I'll try and take a more thorough look.

Edited by systemet, 14 December 2011 - 03:38 PM.

[spenac]

How many are allowed to push it IM?

[croaker260]

How many are allowed to push it IM?

IM in eclampsia only, but lets stay on topic. I have one more day before I turn in my research. Did you vote?

Edited by croaker260, 14 December 2011 - 04:05 PM.

[spenac]

Did not vote. We have multiple options of how to administer. Basically we can administer by any method that is considered current standard of medical practice. Clinical guidelines do not restrict us to how we use it.

IM was still on topic as thought topic was Mag Sulfate.

Edited by spenac, 14 December 2011 - 04:21 PM.

[croaker260]

Did not vote. We have multiple options of how to administer. Basically we can administer by any method that is considered current standard of medical practice. Clinical guidelines do not restrict us to how we use it.

IM was still on topic as thought topic was Mag Sulfate.

OK , fair enough. Would appreciate it if you would vote in the "We give it in some other conposition (please describe below)" box or chose all the ones that apply. Helps the survey results. Also, of you could post the link or text of the order (and/or the service), it would help a lot in my refereces.