From the Guidelines
Magnesium administration during a cardiac arrest code is not routinely recommended, unless torsades de pointes is present, in which case it may be considered (Class IIb, LOE C) 1. The rate of magnesium administration during a code is not explicitly stated in the provided evidence, but it is mentioned that magnesium sulfate can be administered as an IV/IO bolus of 1 to 2 g diluted in 10 mL D5W when VF/pulseless VT cardiac arrest is associated with torsades de pointes 1. Some key points to consider when administering magnesium during a cardiac arrest code include:
- The standard concentration is usually 1 gram in 10 mL (100 mg/mL) 1
- Magnesium works by stabilizing cardiac cell membranes, reducing automaticity, and decreasing the likelihood of arrhythmias
- It's particularly important in patients with suspected hypomagnesemia, alcoholism, or those taking medications that deplete magnesium
- After the initial bolus, continuous infusion may be started at 0.5-1 gram per hour if needed
- Always ensure IV access is secure before administration, as extravasation can cause tissue damage, and monitor for hypotension which can occur with rapid administration However, according to the most recent and highest quality study, the routine use of magnesium for cardiac arrest is not recommended in adult patients (Class III: No Benefit; Level of Evidence C-LD) 1.
From the FDA Drug Label
In paroxysmal atrial tachycardia, magnesium should be used only if simpler measures have failed and there is no evidence of myocardial damage. The usual dose is 3 to 4 g (30 to 40 mL of a 10% solution) administered IV over 30 seconds with extreme caution.
The rate of magnesium administration during a code (cardiac arrest) is not explicitly stated in the provided drug labels for this specific scenario. However, for paroxysmal atrial tachycardia, the rate is 3 to 4 g administered IV over 30 seconds.
- Key points:
- The provided drug labels do not directly address the rate of magnesium administration during a cardiac arrest.
- For paroxysmal atrial tachycardia, the administration rate is specified as 3 to 4 g IV over 30 seconds.
- Caution is advised when administering magnesium, especially in patients with renal impairment or when used in conjunction with other CNS depressants.
- The labels do not provide a specific rate for cardiac arrest scenarios, and thus, no conclusion can be drawn for this particular situation 2, 2.
From the Research
Magnesium Administration Rate
- The rate of magnesium administration during a code (cardiac arrest) is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, the studies provide information on the dosage and administration rates of magnesium in various cardiac conditions:
- A study published in 1997 3 mentions the administration of 2,000 mg magnesium sulfate in patients with torsade de pointes tachycardia.
- Another study from 1992 4 reports the use of magnesium sulfate infusions at a rate of 50 mg/min over 60 min, twice a day for 7 days, in patients with ischaemic dilated cardiomyopathy.
- A 1986 study 5 describes the administration of 1 to 3 g of magnesium sulphate by direct intravenous injection in patients with torsades de pointes.
- A study published in 1986 6 mentions the administration of 10-15 ml of 20% MgSO4 in 1 min and 500 ml of 2% MgSO4 in 5 h in patients without renal failure.
- A more recent study from 2020 7 compares the effects of prolonged versus short infusion rates of IV magnesium in hospitalized patients with hypomagnesemia, with infusion rates of 0.5 g/h and > 0.5 g/h.
Dosage and Administration
- The dosage and administration rates of magnesium vary across the studies, and there is no clear consensus on the optimal rate of administration during a code (cardiac arrest) 3, 4, 5, 6, 7.
- The studies suggest that magnesium can be effective in treating various cardiac conditions, including torsade de pointes, ventricular tachycardia, and hypomagnesemia, but the optimal dosage and administration rate may depend on the specific condition and patient population 3, 4, 5, 6, 7.