Magnesium & Calcium

Magnesium sulfate

Magnesium sulfate

Electrolyte

• Antagonizes calcium and blocks calcium channels causing:
•      Bronchial smooth muscle relaxation
•      Vasodilation
•      CNS depressant effective in the management of seizures from eclampsia
• Anti-arrythmic action related to maintaining intracellular K+ & blocking Ca++ channels
• Reduces myocardial irritability secondary to hypomagnesemia
• Reduces acetylecholine release from neurons causing:
•      CNS depressant effective in the management of seizures from eclampsia
•      Blocks peripheral neuromuscular transmission reducing muscle stimulation

• Severe bronchospasm refractory to inhaled Beta2 agonist
• Torsade de Points
• Refractory V-Fib/Pulseless VTach after anitarrhythmics
• Pregnancy induced hypertension
•      Pre-Eclampsia and/or eclampsia
• Hypomagnesemia

All dosages diluted.  Routes: IV/IO slow push, IV fusion, IM

Adult:

• Severe bronchospasm refractory to inhaled Beta 2 agonist
•      2 grams in 50 or 100cc NS bag infusion over 10 minutes

Why?

          Antagonizes calcium and blocks calcium channels causing bronchial smooth muscle relaxation

• Cardiac Arrest V-Fib / Pulseless V-Tach/Torsades de Points
•      2 gram in 50 or 100cc NS bag infusion over 5 minutes

Why?

          Antiarrhythmic action related to maintaining intracellular K+ & blocking Ca++ channels

• Pre-eclampsia and/or eclampsia
•      4-6 grams in 50 or 100 NS bag infusion over 20 minutes

Why?

•           Antagonizes calcium and blocks calcium channels causing CNS depression
•           Reducing acetylcholine release from neurons causing CNS depression

• Peds:
• Cardiac arrest V-fib/Pulseless V-Tach/Torsades de Points or Torsade with pulse or severe bronchospasm refractory to inhaled Beta2 agonist
•      25-50mg/kg up to 2.0 grams max in 50 cc NS bag infusion over 10 minutes

• Hypermagnesemia 
• Hypocalcemia
• Heart blocks
• Impaired renal function = relative

A

• Digitalis/Digoxin/Lanoxin use can cause dysrhythmias
• Calcium chloride may reverse overdose
• Anticonvulsant may still be needed in eclampsia

• Muscle weakness/paralysis
•      Stop admin if patient loses deep tendon reflexes or has respiratory depression
• Itching / Flushing / Burning
• Nausea
• Depressed cardiac function / Heart block / Asystole
• Sweating
• Hypotension, usually transient
• Hypocalcemia
• Hypermagnesemia
• CNS depression
• Circulatory collapse

• IV:  Seconds
• IM: 1 hour

Varies

10 x 1 gram in 2cc vials (0.5mg/cc)

Calcium Chloride 10%

Caclium Chloride

Electrolyte

• Increases serum calcium ion levels
•      Increases muscle force of contraction
•      Increased neurotransmitter release

• Calcium channel blocker OD
• Pretreatment for Verapamil
• Hyperkalemia

All dosages are IV push

Adult:

• Calcium channel blocker OD, Hypocalcemia, Hyperkalemia, Hypermagnesemia
•      Calcium Chloride 10% 0.5-1.0 gram IV push.  May repeat in 10mm
• Pretreatment of Verapamil
•      Calcium Chloride 10% 2-4mg/kg IV push

• Digitalis, Lanoxin, Digoxin (may cause asytole or gig toxicity)
• Hypercalcemia

• Digitalis, Lanoxin, Digoxin may cause asytole or gig toxicity
• Don't give in smae IV as another drug unless line flushed well

• Bradycardia
• Asystole
• Tissue necrosis if infiltrates

Immediate

2 x 1 gram in 10 cc (10% solution) prefilled syringe