Need some reassurance.

[Spritenurse1210, BSN, RN]

I had a patient with a serum magnesium of 1.8. According to my facility, their accepted normal range for serum magnesium is 1.8 to 2.5. The day shift hospitalist had ordered Magnesium 1 Gram IV one time dose. I didn't feel right about giving the medication, and called the night shift hospitalist. The night shift hospitalist told me to hold the dose, since his serum magnesium was within normal range. I just wanted some reassurance that I did the right thing. I've only worked in Med/Surg for roughly 9 months. Thanks for understanding my brief moment of insecurity.

((hugs))

Jess:D

[Nursey103, ADN, RN]

Looks like you did the right thing :)

[Pepper The Cat, BSN, RN]

Had the magnesium level been dropping over the past few days or was this a one time low?

Perhaps if the level has been slowing dropping they were trying to prevent it from going below normal.

I always find that it is important to look at treands when you get an abnormal blood result.

[KneKno]

You followed policy, so it's not wrong. Some pt's though, "need" a higher mg than the low end of the lab range, same goes for K. In my facility, a huge majority of pt's have a cardiac history--mid to high normal ranges for Mg and K lessens the chances of heart rhythm disturbances.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

I'm not so impressed by the numbers as I am that you felt uncomfortable about an order and did the right thing. That will save lives and your career. Good work.

[Isitpossible, LPN, LVN]

still a student but one question...was the med ordered to keep patient in normal range? were the levels dropping which is why they ordered the one time dose?

[Ruby Vee, BSN]

a good question! i see that you asked the night shift hospitalist about holding the drug, which is a good thing.

you didn't tell us what was wrong with the patient or why the magnesium was ordered. when a cardiac patient has arrhythmias, 6 gm of magso4 is one of the first things that's ordered, even if the mag level is wnl. there are other reasons, too. i think i would have asked the ordering physician for the rationale for giving mag with a level of 1.8. could be he/she already knew about the level but wanted it given anyway. it sounds like your physicians work shifts, though, and so maybe you weren't able to contact the person who wrote the order.

you were thinking, and that's a good thing. but if you don't know the rationale for an order, it's probably best to find out. and i wouldn't hold a medication without notifying the prescriber.

[I RN A]

Go with your gut feeling. A lot of times it is right. You did the right thing, at least it sounds right to me.

[grandmawrinkle]

I don't think you did anything wrong, but as an FYI to you, 1 gm of Mag is peanuts. Even if you did give it with a level of 1.8, if probably would have only brought your patient's Mag level up to mid-normal range. I would have just given it and not questioned the order knowing the Mg level was borderline low. Like other posters have already said, often times MDs will want a patient's Mg levels a little higher than low-normal due to cardiac histories, etc.

Mag is extremely safe to give. Antepartum patients are put on Mag drips and can tolerate levels much higher than normal -- in the 4's and 5's with no adverse effects. Keep that in mind when someone orders it for your patients, even if it is a big dose with normal levels.

As far as what Ruby said, 6 gm mag with normal levels/arrhythmias may be the standard of care where she works, but FYI I am not sure if this dosing specifically is evidence based or a provider "quirk" (you will discover that many MDs have practice and dosing preferences after awhile, and grow to learn what they are.) I can say that I haven't seen it. Most facilities I have worked at with cardiac patients or arrhythmias will replace Mg to get the level at 2.4 or above.

[DeepFriedRN]

I don't think you did anything wrong, but as an FYI to you, 1 gm of Mag is peanuts. Even if you did give it with a level of 1.8, if probably would have only brought your patient's Mag level up to mid-normal range..

Agree with the above.. It's not that you were necessarily wrong or anything.. But I also agree with those that said looking at the trends in a case like this is important. On the other hand, good for you for paying attention to blood levels and such when administering meds! That's the makings of an excellent nurse.

[regularRN]

Where I work we have protocols for mag and K replacement. Depending on the pt's diagnoses the MD will activate these protocols such that the RNs replace mag until the level is above 2 and/or K is above 4. So whilst a mag of 1.8 is within acceptable limits, if the MD has ordered the pt to be replaced via the mag/K protocol, we would go ahead and do it.

[April, RN, BSN, RN]

Where I work we have protocols for mag and K replacement. Depending on the pt's diagnoses the MD will activate these protocols such that the RNs replace mag until the level is above 2 and/or K is above 4. So whilst a mag of 1.8 is within acceptable limits, if the MD has ordered the pt to be replaced via the mag/K protocol, we would go ahead and do it.

We have the same protocols where I work. I believe the rationale is that a mag level of 2.0 is thought to be cardio-protective.