May be administered by registered competent doctor or nurse/midwife (see below re restrictions for pain management)
Magnesium sulphate | 50% | 1g | 2ml | 4mmol Mg in 2ml | |
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Magnesium sulphate | 50% | 5g | 10ml | 20mmol Mg in 10ml | |
Magnesium sulphate infusion bag | 8% | 4g | 50ml | 16mmol Mg in 50ml | Stocked in Maternity for use as per Q pulse guidelines (loading doses) Also available for use in Haematology/Oncology wards |
Magnesium sulphate infusion bag | 4% | 20g | 500ml | 80mmol Mg in 500ml |
Already in solution
Glass ampoules: Draw up using a 5 micron filter needle
Sodium Chloride 0.9% or Glucose 5% (ref 2)
Intermittent intravenous infusion (administer using an electronically controlled infusion device)
Intravenous injection
Rate of administration
Peripheral line (ref 2)
Central line
Fluid restriction (ref 2,4) | |||
---|---|---|---|
Peripheral line
|
Concentrations above 5% have a high osmolarity. Therefore, before PERIPHERAL administration of concentrations above 5% assess the following
|
If fluid restricted, can use a concentration of 10% (5g (20mmol) in 50ml) While a central line is preferred for this concentration, a large peripheral line may be used if central line access is unavailable Monitor for phlebitis Resite cannula at first signs of inflammation (ref 2) |
|
Central line | If required, the maximum concentration is 20%- each 1ml of 50% injection solution with 1.5ml diluent (e.g. 4g (16mmol) diluted to 20ml) |
Hypomagnesaemia ASYMPTOMATIC patients
|
Initial doses based on levels (ref 1) | |
Magnesium level | ||
0.6 to 0.7mmol/L |
Give 1 to 2g (4 to 8mmol) Administer 1g over one hour, 2g over 2 hours |
|
0.4 to 0.6mmol/L |
Give 2 to 4g (8 to 16mmol) Administer over 4 to 12 hours |
|
less than 0.4mmol/L |
Give 4 to 8g (16 to 32mmol) Administer over 12 to 24 hours and repeat as needed Can give over 4 hours if essential (ref 1) - but note that slower administration may improve retention - see below regarding inefficiency of intravenous magnesium administration Subsequent doses: guided by levels and the patient's clinical condition. Repeated doses may be needed - up to 40g (160mmol) may be needed over up to a five day period (allowing for urinary losses) (ref 3,5) |
|
Hypomagnesaemia Haemodynamically STABLE, SYMPTOMATIC patients (severe symptoms - tetany,arrhythmias or seizures) |
Continuous cardiac monitoring STRONGLY recommended | |
If Mg level <0.4mmol/L: |
Initially, give 1 to 2g as a bolus over 30 to 60 minutes (give as small volume infusion to avoid inadvertently giving too rapidly) Follow with an additional 4 to 8g over 12 to 24 hours Repeat dose as necessary |
|
Mg level 0.4mmol/L or more |
Give 4 to 8g over 12 to 24 hours Repeat dose as necessary |
|
Hypomagnesaemia - Haemodynamically UNSTABLE, SYMPTOMATIC patients (severe symptoms - tetany,arrhythmias or seizures) |
Continuous cardiac monitoring STRONGLY recommended Initially, give 1 to 2g as a bolus over 2 to 15 minutes (may be best to give as small volume infusion to avoid inadvertently giving too rapidly) May repeat as necessary if patient remains unstable Once patient is stable, administer an additional 4 to 8g over 12 to 24 hours. Repeat dose as necessary |
|
Severe acute asthma or continuing respiratory deterioration in anaphylaxis (ref 3,8) |
Give 1.2 to 2g over 20 minutes (should only be used following consultation with senior medical staff) |
|
Emergency treatment of severe arrhythmias (ref 3) |
Give 2g over 10 to 15 minutes Dose may be repeated once if necessary |
|
Eclampsia, Fetal neuroprotection | See Q pulse document: CLN LW 032, CLN LW 0055 | |
For use in pain management (Prescribed by Anaesthetics or Pain team only) (ref 6,7) |
Bolus dose (ref 6):
Subsequent doses (all ward areas) (ref 6)
|
|
Monitor blood pressure, heart rate, respiratory rate and saturations Patient must be on bedrest for the duration of the infusion |
Inefficiency of intravenous magnesium supplementation (ref 1)
Renal dose (ref 5)
Hepatic impairment
Store below 250C
1: Uptodate, accessed online 9th Oct, 2024 (note- there are two separate monographs in UpToDate - Hypomagnasaemia and Magnesium - slightly different we have amalgamated them with our best efforts)
2: Injectable medicines administration guide Medusa, accessed online 9th Oct, 2024
3: BNF accessed online 9th Oct, 2024
4 .Injectable drugs guide, downloaded from medicinescomplete Oct 22nd 2024
5: Martindale accessed online 9th Oct, 2024
6. Expert opinion Dr Olivia Finnerty, Anaesthetics Oct 1st 2019
7. Magnesium - a versatile drug for anesthesiologists, Korean j Anaesthesiol 2013 July 65
8: BTS guidelines on Asthma 2019
Electrolyte