20.02 Magnesium Sulfate in Pregnancy
- Used as an anticonvulsant in the pregnant patient
- Decreases risk of preeclampsia from turning into eclampsia
- Has been used as a tocolytic, but research shows there are other more effective options
- May suppress uterine contractions in the laboring patient
- If given in an actively seizing patient, it is an emergency.
- IV bolus given
- IM injections
- Then continuous IV infusion.
- Given in a preeclamptic patient to prevent seizure
- May be continued up to 24 hours postpartum
- Closely monitor mag levels
- Normal serum mag level is 1.5-2.5 mEq/L
- Target therapeutic range for this indication is 2.5-7.5 mEq/L
- Mag over 12 mEq/L can be fatal
- Closely monitor vitals per protocol/order set
- Closely monitor deep tendon reflexes, respiratory function, heart monitor
- Patellar reflex = legs hanging over bed, use reflex hammer to hit the quadricep tendon, do it on both legs and rate. Suppressed reflex can be a sign of impending respiratory arrest!
- 0 – no response
- 1 – sluggish
- 2 – normal
- 3 – more brisk, slightly hyperactive
- 4 – brisk, hyperactive
- Call if RR is less than 12/min
- Check RR + reflex before IV doses. Reflex MUST be present and RR greater than 16 before each IV dose (unless hospital policy reflects otherwise).
- Watch renal function on BMP or CMP and urinary output (med eliminated by kidneys
- Titrating magnesium based on assessment findings
- Calcium gluconate easily accessible
- Antidote for Magsulfate
- Lab values
- Side effects