mag sulfate

fmrnicumom · Oct 15, 2007

I'm curious about this as well. During my last pregnancy, I went into preterm labor and was on mag sulfate several times over the course of the month before his birth. I hit toxic levels 4 times. I was so out of it I don't remember what they did to try to counteract that, if anything.

Thanks for posting this! :)

Tiffany

Moe75_Rn · Oct 15, 2007

For our mag patients we have dynamap in room, side rails are padded, suction set up and ready to use, mag is on pump, and we have pulse ox in room. We do not have the calcium gluconate at bedside, it is left in the pixis. Hope this helps.

NurseNora, BSN, RN · Oct 15, 2007

During my last pregnancy, I went into preterm labor and was on mag sulfate several times over the course of the month before his birth. I hit toxic levels 4 times. I was so out of it I don't remember what they did to try to counteract that, if anything.QUOTE]
For preterm labor we tend to tolerate higher levels of Mag. Usually it isn't necessary to give Calcium Gluconate because your kidney function is pretty good and turning the Mag down or off will usually get you into non toxic levels fairly quickly. Pre eclamptics, on the other hand, often do not have good kidney function and are more likely to need a reversal agent.
In my hospital, we don't keep the calcium gluconate in the room, but in the pyxis. In 38 years, I've only had to use it once. We used to mix our own and a patient quit breathing as soon as the Mag was started. I think she didn't mix it in the bottle (it was a really long time ago) after adding it to the IV solution and the patient got a really strong concentration.
As far as what I have in the room... If she's preeclamptic, anything needed for a possible seizure. For anyone on Mag I put them on the pulse ox on the monitor, I keep my stethescope handy for checking lungs and for checking reflexes (I can never find a reflex hammer when I need it, the edge of the diaphragm works well), we put a Foley in our Mag patients, if you don't you might want to get a bedside commode handy. When I start the bolus, I have a small basin of ice water into which I put a few wash cloths to cool the patient down when she gets flushed. O2 supplies are always in the room. The crash cart is in the hall nearby.

crissrn27, RN · Oct 16, 2007

Thanks for the replies! I am just curious to see what everyone does. We have suction and O2 in the room, don't put them on pulse ox, and don't pad the siderails. Do have pulse ox and BP in the room (L and D, so it is with the toco). Of course we use the pump, and bolus from the same maintenance bag (does everyone do this?)

I have heard that eventually that we'll have to use a small bag to bolus and then one for maintenance.

fmrnicumom · Oct 16, 2007

I do remember that I was not on a pulse ox and did not have siderails up. I know I couldn't have stood up if I had needed to. When I hit toxic levels, I could not even lift my hand, could barely speak in a whisper. They told me my levels were so high they were surprised I could do that much.

In my case it was due to preterm labor, not preeclampsia, but it's still interesting to learn more about it.

Thanks again. :)

Tiffany

crissrn27, RN · Oct 16, 2007

Oh man, Tiffany, that sounds horrible! I hope you and the baby did OK after! I will try to remember your experience when caring for my mag pts. It doesn't sound like a fun thing to go through.

The ice water wash cloths sound like a good idea too. Gotta remember that one.

PRESLA · Oct 16, 2007

] :idea: At a facility I worked at kept a Labor cart locked at the bedside of all labor pt and undelivered pts. It had all our meds in it and frequent supplies that we used. No narcs, phenergan or other premixed iv fluids that required 2 nsg verification. All very handy!!!! Of course it was designed by the labor nurses.

:wink2: Lisa