PHARMACY GUIDELINES

Intravenous Magnesium Therapy

I. Magnesium Replacement Therapy:

General Information:
• Reference Magnesium Levels:
0.7-1 mmol/L or 1.7-2.43 mg/dL
• Formulary IV Magnesium Preparations:
1 mEq of Magnesium = 0.5 mmol
1 g of magnesium sulfate = 4 mmol
Salt Elemental Magnesium mmol Magnesium/mL mEq Magnesium/mL
Magnesium Sulfate 10 mg Mg++/mL 0.4 mmol 0.8 mEq
10% (100 mg/mL)
Magnesium Sulfate 50 mg Mg++/mL 2 mmol 4 mEq
50% (500 mg/mL)

Hypomagnesaemia: Serum magnesium level of < 0.7 mmol/L. Hypomagnesaemia could be

asymptomatic or symptomatic. Oral replacement is preferred in asymptomatic patients able to
tolerate PO administration.
Intravenous Magnesium Replacement:
• All doses should be specified in mmol (mEq)
• It can be give through peripheral or central venous line
• Bolus dosing (i.e. 5 g over 4 hours) is acceptable if the patient is symptomatic and/or
has a serum level of ≤ 0.5 mmol/L. However, bolus dosing without IV maintenance
infusions provides a false sense of security because:
1. 50% of a magnesium dose is excreted in the urine.
2. Serum (Extracellular Fluid) magnesium accounts for only < 1% of total body
magnesium and equilibrium between the extracellular fluid and the intracellular
stores takes place very slowly.
Body Weight Symptomatic or serum level Asymptomatic or serum level
< 0.5 mmol/L > 0.5 mmol/L and < 0.7 mmol/L
For patients NOT currently on maintenance magnesium
< 50 kg 16-20 mmol/day 12-16 mmol/day
> 50 kg 20-24 mmol/day 16-24 mmol/day
For patients currently on maintenance magnesium
< 50 kg 8-12 mmol/day 4-8 mmol/day
> 50 kg 12-16 mmol/day 8-20 mmol/day
Alternate Adult Dosing Schedule
0.5 mmol/kg/day for 24 hours, then 0.25 mmol/kg/day for 3-5 days

Dilution & Infusion Rate:

• May be mixed with Dextrose 5% or 0.9% sodium chloride solution
• Maximum concentration of magnesium for IV use is 0.4 mmol/mL (10% solution)
• Concentrations most often used is 0.02 mmol/mL (4 mmol/50 mL diluent), if bolus
dosing is required.
• Recommended rate: 1-8 mmol/hour (0.016-0.133 mmol/min)
• Maximum rate allowed 12 mmol/hour (0.2 mmol/min)
• In emergency situations only (if symptomatic hypomagnesaemia is accompanied by
ventricular dysrhythmias/seizures): 10% solution may be given at a rate of 0.6
mmol/min Example: 4 mmol (2 mL) diluted to 10 mL total volume, and given over 7
 minutes Example: 12 mmol (6 mL) diluted to 50 mL total volume, and given over
20-30 minutes
• ICU standard Concentrations:
1. 12 mmol (3 g) in 100 mL Dextrose 5% over 2 hours
2. 16 mmol (4 g) in 100 mL Dextrose 5% over 3 hours

II. Magnesium Sulfate Dosing Guidelines for Labor and Delivery:

1. For Eclampsia Treatment and Prophylaxis:
Bolus Dose: 4 gm of magnesium sulfate in 100 mL of 0.9% Sodium Chloride to run over 1
hour
Maintenance Dose: Prepare 40 gm in 1000 ml of 0.9% Sodium Chloride to be run at 2g/hr
(50ml/hr)
2. For Preterm Labor:
Bolus Dose: 6 gm of magnesium sulfate in 100 mL of 0.9% Sodium Chloride to run over 1
hour
Maintenance Dose: Prepare 40 gm in 1000 ml of 0.9% Sodium Chloride to be run at 3g/hr
(75ml/hr)
Precautions:
•These guidelines are not applicable in patients with renal failure; hypermagnesaemia
may result
• IV calcium gluconate should be readily available to reverse magnesium intoxication
Monitoring:
• Vital signs: every 15 minutes during bolus infusion; respiration rate should be ≥
16/min
• Urine output: should be ≥ 100 mL in the 4 hours preceding the dose
• Laboratory: magnesium level (after each dose), calcium (hypocalcaemia can cause
hypomagnesaemia), potassium and phosphorus (possible intracellular ion depletion)
References:
1. Guidelines for Magnesium Replacement, King Faisal Specialist Hospital & Research Center
2. Guidelines for Magnesium Replacement in Adults, Medical University of South Carolina
Pharmacy Services:
www.musc.edu/pharmacyservices/medusepol/Adult_Magnesium_Guidelines.pdf
3. Magnesium Sulphate-IV Dilution, GlobalRPh Inc.
http://www.globalrph.com/magnesium_dilution.htm
4. Electrolyte Replacement Protocol, Oregon Health & Science University
www.ohsu.edu/medicine/residency/handouts/pharmpearls/Nephrology/ElectrolyteReplacementP
rotocol.pdf
5. Adult Electrolyte Replacement Protocols;
www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf
6. Monitored Unit Electrolyte Replacement Protocols;
www.emcrit.org/misc/electrolyte_replacement.pdf
7. Electrolyte Infusion Guidelines at University of Kentucky Hospital;
http://www.hosp.uky.edu/Pharmacy/formulary/criteria/electrolyte.htm
8. Magnesium Administration Guidelines, Massachusetts General Hospital, Department of Pharmacy
& Department of Nursing Critical Care:
http://www.massgeneral.org/pharmacy/icu%20Guidelines/magnesium.htm
Pharmacy @ January 09