Medications

Magnesium
Generic name: Magnesium
Drug class: Anti-seizure
Dose: Cerebral Palsy (CP) Prophylaxis: 6g bolus
with
1-2g/hr maintenance; Pre-Eclampsia/
Eclampsia: 4g bolus with 1g/hr maintenance
Indications: Preeclampsia, CP Prophylaxis for preterm labor
Contraindications: heart block, MI damage
Side Effects: flushing, diaphoresis, lethargy,
blurred vision, nausea, hypocalcemia, depressed
reflexes, decrease platelet aggregation, cardiac dysrhythmias, respiratory paralysis, circulatory collapse
Fetal/Neonatal Side Effects: decrease variability
of fetal HR, Hypotonia, respiratory depression, decreased suck reflex
DO NOT GIVE WITH NIFEDIPINE!!!

Magnesium/Preeclampsia/Eclampsia
Common Facts

S/S of Preeclampsia: increased BP, proteinuria,

swelling, excess weight gain, visual changes, RUQ
pain, N/V, headache (persistent after intervention),
dizziness
NEVER run Magnesium w/o an IV pump
Patients are at risk for seizure up to 6 wks post delivery
Patients are at an increased risk for postpartum
hemorrhage when receiving mag therapy throughout labor
In cases of preterm labor, magnesium is given for
fetal CP prophylaxis and not used as a tocolytic
Preparing the patient room
Provide seizure precautions and resuscitation
equipment at the bedside:
Bedrails padded
O2 mask open, ready to use
Suction catheter ready to use

Magnesium/Preeclampsia/Eclampsia
Cont.

Potential Mag Labs

Mag level
Preeclamptic labs-CBC, CMP, LDH, Uric acid,
U/A, Protein Creatinine Ratio

Normal Mag level2.5-3.0 mEq/L

TUKH Therapeutic Range for Mag 5.0-7.0
mEq/L

Magnesium/Preeclampsia/Eclampsia
Cont.

S/S of Mag Toxicity: (Symptoms: decrease BP,

decrease reflexes, confusion, cardiac arrhythmias,
decrease kidney function-decrease urine output,
muscle weakness, difficulty breathing)
Magnesium Bolus Protocol
Should be run over 15-30 min
Remain at the bedside for bolus
BP, O2 Sat q5min during bolus
Maintenance of Magnesium Protocol
BP, O2 Sat, HR q15 min
RR, Clonus, Deep Tendon Reflex, I/O q1hrs
Lung sounds q2hrs
Antidote for Magnesium
10% Calcium Gluconate
1 gm IV (10 mL) over 5-10 min
Ok to be in accudose and not at bedside

Magnesium/Preeclampsia/
Eclampsia:

In OR cases:
Discontinue magnesium for CP prophylaxis
Continue magnesium for pre-eclampsia/
eclamspia on IV pump
Notify Dr.s:
Urinary output < 30 mL/hr
Absent patellar reflexes
Respirations < 12/min
Change in reflex or clonus status
Diastolic pressure > 150 mm Hg
If serum magnesium is <5 or >7
Presence of clonus
What to do if your pt seizes:
CALL FOR HELP!
Roll pt to side
Suction ready
Monitor FHT
O2 mask ready
Get IV access and give ordered bolus