IV Magnesium Sulfate in office???

Jolie, BSN · Mar 15, 2013

My experience with IV infusion of mag sulfate comes strictly from the OB setting (as a nurse and patient), so I can't offer any insight on office practices or standards of care.

But I don't understand the use of IV mag sulfate for the treatment of a migraine in an ambulatory patient. The side effects of this drug (especially with rapid infusion) are horrific, and include intense dizziness, nausea, vomiting, weakness, flushing, tachypnea, tachycardia, etc., etc., etc. I can't imagine a migraine so bad that I would be willing to add these symptoms to the mix. Nor do I understand how you would then discharge this patient from the office without a lengthy recovery period, a ride home, and a caretaker.

Aren't there plenty of other options for migraine treatment that are less invasive, and leave the patient in a more functional condition?

I'll check back on this thread. This is very interesting to me :)

CrunchRN, ADN, RN · Mar 15, 2013

I did a search and there are a bunch of research articles about using it very effectively:http://www.ncbi.nlm.nih.gov/pubmed/11251702

None (in a very quick glance) addressed what you are concerned about. You might try e-mailing the author of one of the articles and ask them about how the research subjects did side effect wise and what protocols they used to ensure safety.

monkeybug · Mar 15, 2013

I regularly receive MGSO4 in an office setting. Usually 4 grams IV. It's standard operating procedure for my neurologist, and it's one of the few things out there that will halt a migraine for me. BUT, I'm always hooked up to a cardiac monitor with regular BP checks.

monkeybug · Mar 15, 2013

My experience with IV infusion of mag sulfate comes strictly from the OB setting (as a nurse and patient), so I can't offer any insight on office practices or standards of care.
But I don't understand the use of IV mag sulfate for the treatment of a migraine in an ambulatory patient. The side effects of this drug (especially with rapid infusion) are horrific, and include intense dizziness, nausea, vomiting, weakness, flushing, tachypnea, tachycardia, etc., etc., etc. I can't imagine a migraine so bad that I would be willing to add these symptoms to the mix. Nor do I understand how you would then discharge this patient from the office without a lengthy recovery period, a ride home, and a caretaker.
Aren't there plenty of other options for migraine treatment that are less invasive, and leave the patient in a more functional condition?
I'll check back on this thread. This is very interesting to me :)

Yes, for the "occasional" migraine patient, there are many other options. There is a subset of migraine patient, though, that require heavy duty, sometimes unusual meds. I'm one of those worst-of-the-worst chronic migraneurs. My background is L&D, so I was expecting bad side effects from mag, but honestly, compared to what I was going through with a days long migraine, the mag was NOTHING. I love mag. LOVE IT. I would have it on tap in my home if I could. It's a first line drug for my neurologist. It's cheap and it works when the triptans, NSAIDs, preventatives, and narcotics have failed. Why does it work for migraines? Probably some of the same reasons it prevents seizures in preeclampsia. It's also neuro-protective for fetuses.

If the idea of mag amazes you, then the list of things I've tried over the years would probably leave you speechless. There is only 1 medications FDA approved for migraine prevention, Topomax. But the list of things that migraine specialists will try stretches past 200. I've tried Risperdal, Seroquel, Lamictal, DHE, methergine (yeah, methergine), and Botox just to name a few. And I don't have any mental health dx, so the Risperdal and Seroquel were solely for migraine prophylaxis. I've been given lidocaine, magnesium, steroids, ketamine, benadryl, and toradol in different IV sessions in attempts to break long cycles of migraines. If I walked into my neuro's office for my next visit and he told me that there was a new treatment from Asia involving IV water buffalo urine, I'd probably consent to it because I'm that desperate for relief.

So, in summary, if the migraine patient can usually take something PO or just go to bed, and that's all it takes to get rid of their 3-times-a-year migraine, then mag may be a bit of overkill. But for the patients who are chronic and difficult to treat, mag is a very useful, basic step in treatment.

morte, LPN, LVN · Mar 15, 2013

Have you tried daily PO magnesium?

Yes, for the "occasional" migraine patient, there are many other options. There is a subset of migraine patient, though, that require heavy duty, sometimes unusual meds. I'm one of those worst-of-the-worst chronic migraneurs. My background is L&D, so I was expecting bad side effects from mag, but honestly, compared to what I was going through with a days long migraine, the mag was NOTHING. I love mag. LOVE IT. I would have it on tap in my home if I could. It's a first line drug for my neurologist. It's cheap and it works when the triptans, NSAIDs, preventatives, and narcotics have failed. Why does it work for migraines? Probably some of the same reasons it prevents seizures in preeclampsia. It's also neuro-protective for fetuses.
If the idea of mag amazes you, then the list of things I've tried over the years would probably leave you speechless. There is only 1 medications FDA approved for migraine prevention, Topomax. But the list of things that migraine specialists will try stretches past 200. I've tried Risperdal, Seroquel, Lamictal, DHE, methergine (yeah, methergine), and Botox just to name a few. And I don't have any mental health dx, so the Risperdal and Seroquel were solely for migraine prophylaxis. I've been given lidocaine, magnesium, steroids, ketamine, benadryl, and toradol in different IV sessions in attempts to break long cycles of migraines. If I walked into my neuro's office for my next visit and he told me that there was a new treatment from Asia involving IV water buffalo urine, I'd probably consent to it because I'm that desperate for relief.
So, in summary, if the migraine patient can usually take something PO or just go to bed, and that's all it takes to get rid of their 3-times-a-year migraine, then mag may be a bit of overkill. But for the patients who are chronic and difficult to treat, mag is a very useful, basic step in treatment.

MunoRN, RN · Mar 15, 2013

We use IV magnesium as the first choice for many of our regular migraine patients in the ER. We only see them in the ER on evenings and weekends because otherwise they go to the clinic for infusion. We don't continuously monitor them in the ER or clinic nor do we check levels.

1 gram is a relatively small dose of IV mag. In OB, mothers who are likely to give birth prematurely receive massive doses of IV mag, often without continuous monitoring. 6-10 gram loading doses (over 30 minutes) aren't unusual, typically followed by 2 grams an hour for an extended period of time. You might see some nausea or flushing in these patients, but with a much smaller dose of 1 gram any noticeable side effects are unlikely, but it does treat migraines amazingly well.

Anagray, BSN · Mar 15, 2013

My biggest concern is that this high alert drug is administered in an office setting without a protocol in place, no baseline labs and only with a blood pressure cuff and a manual pulse recordings.

My co-workers and I had a meeting about this with our supervisors and feel like our concerns are being basically presented as exaggerated and unreasonable.

I am an experienced nurse and giving this drug in a hospital setting is a completely different experience.

We at least will get our wish of having a protocol established but i am not comfortable with this at all.

evolvingrn, BSN, RN · Mar 16, 2013

My biggest concern is that this high alert drug is administered in an office setting without a protocol in place, no baseline labs and only with a blood pressure cuff and a manual pulse recordings.
My co-workers and I had a meeting about this with our supervisors and feel like our concerns are being basically presented as exaggerated and unreasonable.
I am an experienced nurse and giving this drug in a hospital setting is a completely different experience.
We at least will get our wish of having a protocol established but i am not comfortable with this at all.

I don't understand your discomfort. I give it very slowly per ordered rate but I give it all the time to surgical pts , and they don't always have a baseline mg when we're giving it . We do no special monitoring with this and. Tele is not required

Vespertinas · Mar 16, 2013

You wouldn't need baseline labs because it would take a lot to start experiencing symptoms of overdose.

Each gram IV is supposed to increase serum levels what, ~0.25mg? That's really nothing that would necessitate cardiac monitoring.

Anagray, BSN · Mar 16, 2013

I feel that office and hospital are completely different settings as far as patient safety goes.

evolvingrn, BSN, RN · Mar 16, 2013

I agree, Pts that are in a hospital are requiring ACUTE care, and need more careful monitoring. I don't know how that is an argument that you can't given a mg bolus. it sounds like you just don't want to give infusions.