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# Magnesium Sulphate
## Overview
Magnesium sulphate is an electrolyte replacement and anticonvulsant.
## Primary Indications
* Hypomagnesemia
* Preeclampsia/Eclampsia
## Adult Dosing
### Hypomagnesemia
* **Severe symptomatic hypomagnesemia:** 4-5 grams (32-40 mEq) IV infusion over 10-15 minutes, followed by 2-4 grams (16-32 mEq) as a continuous infusion or intermittent doses over 24 hours.
* **Asymptomatic hypomagnesemia:** 1-2 grams (8-16 mEq) IM or IV every 6 hours for 4 doses.
* **Maintenance:** Dosing varies based on serum magnesium levels and renal function. Consult local protocols.
### Preeclampsia/Eclampsia
* **Loading dose:** 4-6 grams (32-48 mEq) IV infusion over 5-10 minutes.
* **Maintenance dose:** 1-2 grams (8-16 mEq) per hour IV infusion. Adjust per local protocol.
* **Eclampsia seizure treatment:** 4 grams (32 mEq) IV bolus over 5 minutes if blood pressure is not severely elevated; may repeat doses as per ACLS guidelines or local protocol.
## Pediatric Dosing
Dosing is highly individualized and depends on the indication, age, weight, and serum magnesium levels. Consult pediatric-specific guidelines or local protocols.
## Dose Adjustments
* **Renal Impairment:** Reduce dose and monitor serum magnesium closely. Use with extreme caution in severe renal impairment.
## Contraindications
* Hypermagnesemia
* Heart block
* Myocardial infarction (relative contraindication)
* Severe renal impairment (relative contraindication)
## Adverse Effects
* Flushing, sweating, hypotension, nausea, vomiting, drowsiness, decreased reflexes, muscle weakness, respiratory depression, cardiac arrest.
## Key Drug Interactions
* **Neuromuscular blocking agents:** May potentiate neuromuscular blockade.
* **Calcium:** May antagonize the effects of magnesium.
* **Certain antibiotics (e.g., tetracyclines, aminoglycosides):** May decrease absorption or potentiate neuromuscular blockade.
## Monitoring
* **Serum magnesium levels:** Frequently monitor, especially during loading doses and with renal impairment.
* **Renal function:** Assess baseline and monitor during therapy.
* **Deep tendon reflexes:** Assess for signs of hypermagnesemia.
* **Respiratory rate:** Monitor for respiratory depression.
* **Urine output:** Monitor for adequate renal function.
* **Blood pressure:** Monitor, especially in preeclampsia/eclampsia.
## Clinical Pearls
* Magnesium sulphate should be administered cautiously and with close monitoring.
* In case of suspected hypermagnesemia, discontinue infusion and administer calcium gluconate.
* Ensure adequate hydration and urine output.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for any questions regarding medications. Dosing and protocols may vary based on local guidelines and individual patient factors.
