Yes, I agree.
1. We get perhaps one patient per year who needs frequent monitoring of this
ultra-high dose iv Mg treatment, effective (& in literature) for patients
with frank Tetanus as well as for Eclampsia.
2. Our Cardiologists are confident that there is NO indication for
monitoring the serum Mg in routine iv use for MI, arrythmias, etc.
3. Our (adult) ICU director has long agreed with us that a once-a-week serum
Mg may act as a crude surrogate to exclude trace nutrient deficiency so that
is all in the routine ICU protocol.
However, other units with softer protocols do ask for once daily Mg on a few
patients - a point for discussion when we spot it - but not (so far) three
times a day after meals.
Best wishes,
Les
> From: "Robertson, Stuart" <[log in to unmask]>
> Reply-To: "Robertson, Stuart" <[log in to unmask]>
> Date: Tue, 23 Jul 2002 13:58:07 +0100
> To: [log in to unmask]
> Subject: Re: Magnesium infusions
>
> Mike,
> Don't have a definite answer to your question, but related to it is the
> recommended use of prophylactic IV magnesium as an anticonvulsant in
> pre-eclampsia (outcome of MAGPIE trial).
> I have seen published guidelines recommending a target therapeutic range for
> serum magnesium of 2 - 4 mmol/L, with toxicity at >6 mmol/L.
> However, I don't recall ever being asked to do magnesiums in this situation
> (yet), and I believe that the obstetricians check for Mg toxicity purely by
> monitoring the patellar reflex for hyporeflexia.
> Best wishes,
> Stuart
>
> Stuart Robertson
> Clinical Biochemistry Dept
> Hull Royal Infirmary
> HU3 2JZ
>
> ----------
> From: [log in to unmask] [SMTP:[log in to unmask]]
> Sent: 23 July 2002 11:05
> To: [log in to unmask]
> Subject: Magnesium infusions
>
> Like many of you I suspect we have observed an exponential rise in
> requests or plasma magnesium from our ICU in the last few years.
> This started with patients with meningococcal meningitis but now
> almost all patients have magnesium results several times a day. I
> confess to not having done an extensive literature search but I am
> pretty sure that the evidence base for the clinical usefulness of
> these
> measurements is pretty thin. It must be incredibly difficult to
> sort out
> the effects of a low plasma magnesium from all the other problems in
> patients on ICU.
>
> However, now a new phenomenon has arisen which is the treatment of
> patients plasma magnesium concentrations in the low normal range
> with magnesium infusions leading in at least one case to a
> concentration well above the upper reference limit. On talking to
> one
> of my adult colleagues I find we are not alone and this is happening
> elsewhere. Can anyone shed any light on this? Are there real
> dangers
> in this apparently cavalier approach to treating biochemistry and
> not
> the patient?
>
> Mike Addison
> .
> Dr G.Michael Addison
> Royal Manchester Children's Hospital
> Pendlebury
> Manchester M27 4HA
> United Kingdom
>
> Tel 0161-727-2250(AM)or 0161-220-5342(PM)
> FAX 0161-727-2249
> Email [log in to unmask]
>
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