![]() Avoid using nonstandard concentrations, and administer bolus doses using separate premixed piggybacks, not from the maintenance infusion. Magnesium toxicity antidote free#Simpson and Knox also suggest using 20 g/500 mL premixed solutions (not 40 g/L) to reduce harm in the event of a free flow incident. Instead, use a standard concentration of commercially available premixed solutions for bolus doses and maintenance infusions. Nurses should not have to mix magnesium sulfate solutions. To reduce the risk of harm when administering magnesium sulfate to obstetrical patients, consider the following: Simpson and Knox noted that patient transfers to units with lower staffing levels and chaotic environments with changing nursing assignments were the most common factors among seven errors that resulted in death. The admixture label had been placed on the wrong bag of Lactated Ringers. Analysis of the solutions revealed that the maintenance solution (300 mL/hour) contained 40 g of magnesium sulfate, and the bag labeled as magnesium sulfate contained only Lactated Ringers. Later, family members found the patient breathless and pulseless. A short time later, the nurse observed the patient sleeping. The nurse told her these symptoms were expected. Several hours later, the patient reported feeling flushed and nauseated. After administering a 6 g bolus dose, she started the infusion at 3 g/hour and hung a maintenance solution of Lactated Ringers at 300 mL/hour. The patient actually received a 12 g loading dose but subsequently recovered without permanent harm.Ī nurse retrieved two bags of Lactated Ringers from unit stock and added 40 g of magnesium sulfate to one bag. The nurse had misread the vial labels and added too much magnesium sulfate to the IV bag. Concerned about toxicity, the physician ordered a test of the solution, which revealed a concentration of 80 g/L. The patient was flushed and nauseated, with shallow respirations and unable to move her extremities. She returned 25 minutes later to find the patient had received a 6 g loading dose. After remaining with the patient for 20 minutes, the nurse was suddenly called away for an urgent problem. The patient developed signs of magnesium toxicity, but the error was discovered before further harm resulted.Ī nurse prepared a bag of magnesium sulfate (40 g/L) and began an infusion at 200 mL/hour to deliver a 4 g bolus dose (100 mL) over 30 minutes. The oncoming nurse subsequently increased the rate of infusion because she was unaware the patient was receiving a double-strength solution. The change-of-shift report was hurried due to an emergency Cesarean section. The nurse forgot to transcribe the verbal order and did not re-label the single-strength bag to which she had added additional magnesium sulfate. After transfer to the busy, understaffed postpartum unit, the patient was later found in respiratory arrest and developed anoxic encephalopathy.ĭue to fluid restrictions, a physician gave a verbal order for a double-strength solution of magnesium sulfate to be administered at 2 g/hour. The mother had preeclampsia, so she had an existing magnesium sulfate solution infusing when the second solution was hung. The mother was found unresponsive and remains in a persistent vegetative state.īefore transfer, a nurse accidentally replaced a mother's depleted Lactated Ringers solution with an unlabeled liter bag of magnesium sulfate prepared by another nurse for a different patient. The oxytocin solution was connected to the patient, but the magnesium sulfate solution was actually started by mistake. The magnesium sulfate infusion had been administered during preterm labor, but it remained connected at the Y-site to the patient although it had been discontinued and was no longer infusing. Examples from the article follow:Ī nurse accidentally restarted an infusion of magnesium sulfate instead of beginning a new infusion of oxytocin after a mother had delivered her baby. In the article, they described 12 cases in detail, revealing common precipitating events. 1 In the span of a few years, the authors, who are involved in ongoing review of obstetrical accidents in the US, accumulated 52 reports of accidental overdoses of magnesium sulfate. More recently, a detailed account of errors with this drug was published. Most of these errors were due to unfamiliarity with safe dosage ranges and signs of toxicity, inadequate patient monitoring, pump programming errors, and mix-ups between magnesium sulfate and oxytocin. In our February 12, 1997, and Jnewsletters, we described errors in which obstetrical patients suffered respiratory arrest after receiving overdoses of magnesium sulfate. Yet, many errors have been reported with this medication, some fatal. Problem: Practitioners who work in obstetrical units may feel comfortable administering IV magnesium sulfate, which is used to treat preterm labor and preeclampsia. ![]()
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