Magnesium sulfate question

[Kdavisobrn]

I was wondering, what does your hospital policy say about some specifics of mag sulfate for treatment and management of preeclampsia/ eclampsia?

1. What is the activity order?

2. What is the diet order?

3. PO fluid restrictions?

4. Are mag levels serially drawn for all mag pts or just if pt is symptomatic?

[klone, MSN, RN]

Bedrest

Clears

Yes, but can't speak to the specifics

Currently it's serial, but we're in the process of updating our orderset, and mag levels will be one of those changes, so that it will be drawn PRN for symptoms

[Kdavisobrn]

Our facility doesn't currently put pts on bedrest, had one of our section pts get up before I got there, then I got some dirty looks this morning when I didn't have her ambulatory after my shift. They fed her regular food all day long as well, and while I agree that there are situations where it seems appropriate to let them eat, hers wasn't one of them. Any body have an opinion?

[MotherToPeanut]

According to our policy, patients on mag sulfate are to be on bed rest. Physician may order bathroom privileges. Diet can range from NPO to sips of clear liquids depending on the patient's condition. IV fluids are restricted to 125 mL/hr. Serial mag levels are drawn every 4 to 6 hours.

[MJC2118, APRN]

Bed rest, NPO or clears, IVF rate depends on Mag rate to total no more than 125 ml/hr, and mag levels are drawn PRN for s/s

[MJC2118, APRN]

Our patients are on Mag for either preeclampsia or PTL, and is usually initiated immediately. With both of these scenarios, the patient should not be eating food (in case of c/s) and should not be up walking around (which isn't exactly safe with Mag, period). So I'm not sure why your coworkers were up in arms about this.

[MJC2118, APRN]

Sorry, I just realized you said section patient. Usually in this situation, diets are advanced as tolerated but activity is usually minimal until Mag is off.

[ashleyisawesome, BSN, RN]

1. Generally they are on bedrest with bathroom privileges, but if they are a postpartum NICU mom, we usually let them visit NICU in a wheelchair with an RN escort. I also let them get into the chair with assistance, but I don't let them walk around without help.

2. No diet restrictions related to the Mag. If they are in labor it's clear liquids, if they are PP they are on a regular diet.

3. They usually have a 1500-2000ml Fluid restriction (including IVF, so we usually run the mag at 25/hr and the fluids at 30/hr). Moms on mag for neuro protection generally don't have a FR though.

4. For pre-eclamptic patients on mag, we usually do q6h mag levels. If they are on it for neuro protection with preterm labor we don't check labs unless they are symptomatic.

[ama3t]

I only care for PP mags. They are strict bed rest, NPO, fluids at 75 (in general). No routine labs but hourly checks including some combo of vitals, breath sounds, DTRs, UOP. They always have a Foley.

[JackieShorter]

depends on the doc

usually bedrest or oob with assist

clears. but some patients have fussed enough that docs have ordered a regular diet

no fluid restrictions generally

levels arent drawn serially.

[PeakRN]

Depends greatly on why they were placed on a mag drip. We are a huge high risk OB facility and we cannot keep someone on bedrest for weeks or months at a time, let alone tell them not to eat for that length of time.

1: High risk fall, needs to be ambulated with supervision.

2: Not dependent simply on the mag drip.

3: Not dependent simply on the mag drip.

4: Labs depend on the patient's presentation, and are advanced as the patient's condition becomes more stable.