Magnesium Sulfate Protocol
Primary IV
1. Lactated Ringer’s: Titrate to keep total IV intake at 125 mL/hr.
Magnesium sulfate
1. Loading dose: Magnesium sulfate 4 g IV loading dose over 20 min x 1 dose.
2. Maintenance dose (after loading dose): 2 g/hr.
Labs
Admission:
1. Complete blood count – Done on adm
2. Prothrombin time– Done on adm
3. Partial thromboplastin time– Done on adm
4. Fibrinogen; lactate dehydrogenase– Done on adm
5. Dipstick urine for protein on admission, – Done on adm
6. Initiate 24-hour urine collection started
7. Comprehensive metabolic panel - Done on adm
8. Serum uric acid- Done on adm
9. Magnesium level 4 hours after loading dose of Magnesium sulfate- Done on adm- waiting
for results
Additional:
1. Dipstick urine for protein every 4 hours
2. Magnesium level every 6 hours
3. Stat magnesium level for respiratory rate less than 12
4. Dipstick urine for protein every 4 hours
Output:
Insert Foley catheter – monitor hourly output
Diet: NPO except ice chips
Activity: Reduced environmental stimulation (i.e., darkened room, limited visitors), bedrest only
Precautions:
Seizure
Emergency Medications & Treatment
1. Respiratory Arrest (RR less than 12 or O2 sat less than 95%)
oStop Magnesium Sulfate
oCalcium gluconate 10%: 1 g (10 mL) slow IV push over 5 minutes for respiratory rate
less than 12
oStat Lab: Magnesium level for respiratory rate less than 12
oOxygen: Administer O2 at 10 L via facemask for RR less than 12 or O2 sat less than
95%
2. Hypertensive Emergency (SBP >/= 160 OR DBP >/= 110)
oLabetalol 20 mg IV over 2 minutes
Repeat BP in 10 minutes, if still elevated, administer Labetalol 40 mg IV over 2
minutes
oHydralazine 5 mg IV over 2 minutes
Repeat BP in 20 minutes, if still elevated, administer Hydralazine 10 mg IV
over 2 minutes
(Continued)
1
