Is administering 1gm of intravenous (IV) magnesium sulfate appropriate for a patient with dengue fever and hypomagnesemia?

Intravenous Magnesium Sulfate 1g is Appropriate for Hypomagnesemia in Dengue Fever

For a patient with dengue fever and hypomagnesemia, administering 1g of intravenous magnesium sulfate is appropriate and aligns with current guidelines. 1, 2

Dosing Guidelines for Hypomagnesemia

• For mild magnesium deficiency, the standard adult dose is 1g of magnesium sulfate IV, which is equivalent to 8.12 mEq of magnesium 2
• The American Heart Association recommends administering 1-2g IV over 15 minutes for acute hypomagnesemia 3
• For severe hypomagnesemia, up to 250mg/kg body weight may be given, or alternatively, 5g can be added to IV fluids for slow infusion over three hours 2
• Magnesium replacement is specifically recommended for the management of hypomagnesemia [Level V, C evidence] 1

Administration Technique

• IV solutions must be diluted to a concentration of 20% or less prior to administration 2
• The rate of IV injection should generally not exceed 150 mg/minute 2
• Common diluents include 5% Dextrose Injection and 0.9% Sodium Chloride Injection 2
• Maintenance therapy should be titrated based on serum magnesium levels, with a target range of 1.3-2.2 mEq/L 3

Monitoring and Precautions

• Monitor serum magnesium levels and clinical status to avoid overdosage 2
• Clinical indicators of safe dosing include presence of patellar reflex and adequate respiratory function (≥16 breaths/min) 2
• Have calcium immediately available to counteract potential magnesium toxicity 3, 2
• Use with caution in patients with renal impairment as magnesium is eliminated solely by the kidneys 2
• Ensure urine output is maintained at ≥100 mL during the four hours preceding each dose 2

Specific Considerations for Dengue Fever

• Hypomagnesemia is a recognized complication in dengue fever that requires correction 4
• Correction of hypomagnesemia is crucial to avoid refractory hypokalemia, which can lead to severe consequences in dengue patients 4
• Hypomagnesemia may manifest with neuromuscular symptoms including irritability, nystagmus, seizures, contractures, and severe pain 1
• IV magnesium sulfate replacement can effectively reverse these symptoms 1

Drug Interactions

• Use with caution when administering with CNS depressants, as magnesium has additive CNS depressant effects 2
• Exercise extreme caution in digitalized patients, as serious changes in cardiac conduction may occur if calcium administration becomes necessary 2
• Be cautious with concurrent neuromuscular blocking agents due to risk of excessive neuromuscular block 2

In conclusion, 1g of IV magnesium sulfate is an appropriate dose for treating hypomagnesemia in a patient with dengue fever. This dose aligns with FDA-approved dosing guidelines and clinical recommendations for mild to moderate hypomagnesemia.