Mg Sulfate Ryder on PCU Patient

[raindrop]

Reporting nurse reported that my 78yo sepsis patient has been throwing frequent PVC and his Mg was low 1.7 , K+ was normal. She made the floor NP aware of the PVCs and the NP ordered a 1Gm MG Ryder. The nurse called her to clarify the order, she was hesitant to hang Mg on a patient getting Levophed for extremely dumpy pressures, on Bipap and is lethargic. The NP discontinued the order, but she wasn't happy about it, and she said she would let the hospitalist listen to the nurses concerns when he was to take over for the day. He never addressed it, so the pt continued to have PVCs throughout the day.

I understand that Mg can cause cardiac arrest and CNS depression if given too much or too fast. But 1 gram? I don't think I would've questioned it. Do you agree with me or am I missing something?

[MunoRN, RN]

I would agree that it was silly for the nurse to be opposed to 1 gram of mag for a level of 1.7 with ectopy present. When large doses are given rapidly there is some risk of affecting blood pressure and nausea, but that generally applies more to OB size doses (rapid boluses of 10 grams, sometimes repeat boluses of 10 grams). Lethargy occurs at levels well above what OB doses produces and definitely well above what 1 gram for 1.7 would produce.

[offlabel]

The NP should not have backed down. That's part of being an NP. The nurse can question all she wants. 2 gms would have been reasonable, let alone one.

[Dodongo, APRN, NP]

I would have ordered 2gms mag. That NP is obviously not confident in his/her clinical knowledge/abilities. Pretty much the only time I even bat an eye with IV mag is in myasthenia (avoid altogether) or hypokalemia (replete K+ first).

[EllaBella1, BSN]

I wouldn't have hesitated to give that mag and then some.

[RN_atlast]

The patient is already on levophed, unless they’re maxed on levo and it’s time to get another pressor on board which is a different issue in itself, why would the mag be questioned? mg and K are electrolytes you look out for especially in regards to ectopy.