Magnesium Sulfate in Asthma

[VentMonkey]

And you have major issues if you didn't see it coming. Look it up. The general rule of basic underlying thought process is to avoid further acidifying a hypercapnic patient. (Remember that thing about CO2 being an acid?) Of course its a rather old school thought process....that let me guess they don't teach anymore??? And I'm willing to bet that an asthmatic is probably going to be significantly hypercapnic by the time they call us up. Just a hunch. So, Gee, Barbie, why don't you get your panties out of a wad, apply your lipstick to the right side of your face, and get on with yourself. Because FRANKLY I don't have time for what ever personal agenda you have going on. [Slam door in face HERE]

Aren't you the same guy who claimed to be a med student, and now a paramedic? Which one is it? Both? Meh, either way yet another troll banned soon enough. You make absolutely no sense to anyone on here, quit while you're ahead.

So, Gee, Barbie, why don't you get your panties out of a wad, apply your lipstick to the right side of your face, and get on with yourself. Because FRANKLY I don't have time for what ever personal agenda you have going on. [Slam door in face HERE]

And to this I say: "Shirley, you can't be serious." The guy is a reputable paramedic respected on here, and you? Well, you're 77 posts in without a single like. Take a hint already, bud.

 

[StCEMT]

How much will a mag drip effect their pH? If it works, they will breathe better. If they breathe better, then they can start breathing off that CO2. So yea, you might add something acidic, but they are better able to compensate for it.

 

[VentMonkey]

How much will a mag drip effect their pH? If it works, they will breathe better. If they breathe better, then they can start breathing off that CO2. So yea, you might add something acidic, but they are better able to compensate for it.

The biggest worry that I was taught, and it isn't anything to take lightly, is hypermagnesemia. Probably not something you're going to induce with 1-2 grams in a 50-100 NS bag, but definitely worth keeping in the back of your mind. Now riddle me this young padawon:

What's your reversal agent?*

*it's carried in every ALS kit/ gear/ system/ protocol that I know of.

 

[bakertaylor28]

Aren't you the same guy who claimed to be a med student, and now a paramedic? Which one is it? Both? Meh, either way yet another troll banned soon enough. You make absolutely no sense to anyone on here, quit while you're ahead.

And to this I say: "Shirley, you can't be serious." The guy is a reputable paramedic respected on here, and you? Well, you're 77 posts in without a single like. Take a hint already, bud.

Its called being an EMT-P (mostly working special events, extra staffing, sick leave, etc.) While going to med school. I would suggest you familiarize yourself with that concept as that's how things work anymore in order to pay for things, as some of us were not born with the silver spoon in our mouths and hence have to find ways to put extra money in the bank to FUND med school - and unfortunately, minimum wage jobs just don't cut the butter anymore.

 

[VFlutter]

How much will a mag drip effect their pH? If it works, they will breathe better. If they breathe better, then they can start breathing off that CO2. So yea, you might add something acidic, but they are better able to compensate for it.

You can trend ETC02. For every 10 change in PC02 you should get about 0.08 change in ph in the opposite direction. It will be an estimate unless you know the patients actual ETC02/PC02 gradient.

 

[bakertaylor28]

The biggest worry that I was taught, and it isn't anything to take lightly, is hypermagnesemia. Probably not something you're going to induce with 1-2 grams in a 50-100 NS bag, but definitely worth keeping in the back of your mind. Now riddle me this young padawon:

What's your reversal agent?*

*it's carried in every ALS kit/ gear/ system/ protocol that I know of.

Calcium Gluconate is the definitive antidote to Magnesium Sulfate.

 

[Handsome Robb]

This is so entertaining.


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[VentMonkey]

Calcium Gluconate is the definitive antidote to Magnesium Sulfate.

You must work at one well funded event stand by service, and hardly a silver spoon in my mouth. Last I checked CaCl- was just as effective, lasted longer, and was plenty available and stocked within most ALS protocols. But whatever you say, you're the doctor. You ain't worth a ban hammer, killer.

 

[gonefishing]

You must work at one well funded event stand by service, and hardly a silver spoon in my mouth. Last I checked CaCl- was just as effective, lasted longer, and was plenty available and stocked within most ALS protocols. But whatever you say, you're the doctor. You ain't worth a ban hammer, killer.

In case he doesn't know or forgot that's Calcium Chloride [emoji6]

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[bakertaylor28]

You must work at one well funded event stand by service, and hardly a silver spoon in my mouth. Last I checked CaCl- was just as effective, lasted longer, and was plenty available and stocked within most ALS protocols. But whatever you say, you're the doctor. You ain't worth a ban hammer, killer.

It is true that the two are pretty well bio-equivalent. However, We also optimally don't want to be overdoing the chloride ion, either. Remember that since NS is a chloride and in practice there is a sizable list of drugs that are compounded as clorides, we will end up eventually raising the chloride levels in the CMP to some degree or another. (which can cause dehydration, diarrhea, vomiting, and kidney failure, among other things, if the chloride level is raised enough.) Hence, the reasoning behind the Gluconate instead of the chloride, but either way.

 

[gonefishing]

It is true that the two are pretty well bio-equivalent. However, We also optimally don't want to be overdoing the chloride ion, either. Remember that since NS is a chloride and in practice there is a sizable list of drugs that are compounded as clorides, we will end up eventually raising the chloride levels in the CMP to some degree or another. (which can cause dehydration, diarrhea, vomiting, and kidney failure, among other things, if the chloride level is raised enough.) Hence, the reasoning behind the Gluconate instead of the chloride, but either way.

Your service has this at hand?.....

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[TXmed]

Getting back on topic instead of the bickering match.

I have used Mag for asthma several times and i believe it works well. Although i encourage everyone to go to epi (IM or inhaled) early and often. I believe prehospital we use Mag,epi, and CPAP too late and would better served using it early rather than later. It is always better to be active rather than reactive. it does not bother me when a receiving doctor says "that was a little overkill dont ya think?".

As far as the hypermagnesia i believe (not certain) it is more of a concern for higher dosages than 50mg/kg or for longer use such as eclampsia with mag drip lasting several hours rather than 1-2grams over 10-20minutes.

* DISCLAIMER* i have never treated nor caused hypermagnesia

 

[VFlutter]

As far as the hypermagnesia i believe (not certain) it is more of a concern for higher dosages than 50mg/kg or for longer use such as eclampsia with mag drip lasting several hours

Agreed. Never happened to me personally but It has happened on our HROB transfers a few times.

 

[VentMonkey]

Getting back on topic instead of the bickering match.

I have used Mag for asthma several times and i believe it works well. Although i encourage everyone to go to epi (IM or inhaled) early and often. I believe prehospital we use Mag,epi, and CPAP too late and would better served using it early rather than later. It is always better to be active rather than reactive. it does not bother me when a receiving doctor says "that was a little overkill dont ya think?".

As far as the hypermagnesia i believe (not certain) it is more of a concern for higher dosages than 50mg/kg or for longer use such as eclampsia with mag drip lasting several hours rather than 1-2grams over 10-20minutes.

* DISCLAIMER* i have never treated nor caused hypermagnesia

I like it too and have had similar success at times. As far as Epi goes, any adult 40 plus years of age with the co-morbidities who also smoke doesn't get it.

I'll forego the Epi in favor of the in-line DuoNeb and a Mag. gtt, time permitting refractory to CPAP and DuoNebs alone.

 

[TXmed]

I like it too and have had similar success at times. As far as Epi goes, any adult 40 plus years of age with the co-morbidities who also smoke don't get it.

I forego the Epi in favor of the in-line DuoNeb and a Mag. gtt, time permitting refractory to CPAP and DuoNebs alone.

Ive had some good success with inhaled epi early. example being a person who has used their albuteral inhaler several times and calls, ill use inhaled epi and follow it with an A&A if need be.

as far as the epi in the 40+ patients, i understand the thought behind the contraindication but see it more as something to take into account. if their respiratory status is to the point i wanna give epi then i believe (as well as my MD) that the risk/benefit leans more towards epi being used. i might reduce my dose or what just a little longer to give it (we dont carry terb). but if need be i will give it, especially to help avoid RSI (which is hard on the heart).

 

[Carlos Danger]

It is true that the two are pretty well bio-equivalent. However, We also optimally don't want to be overdoing the chloride ion, either. Remember that since NS is a chloride and in practice there is a sizable list of drugs that are compounded as clorides, we will end up eventually raising the chloride levels in the CMP to some degree or another. (which can cause dehydration, diarrhea, vomiting, and kidney failure, among other things, if the chloride level is raised enough.) Hence, the reasoning behind the Gluconate instead of the chloride, but either way.

Is that really the reasoning behind Ca gluconate vs. Ca choride?

What happens to the chloride ion in the body?

It works and all in terms of the theory of muscle relaxant properties, but for the fact that Magnesium Sulfate is a mild acid ( pH of approximately 5.5 - 6.5 ) Hence, it would stand that since elevated CO2 tends to cause respiratory acidosis, we wouldn't want to be making things more acidic. (Think the reasons we use Sodium Bicarbonate in cardiac arrest cases.)

Does elevated C02 cause respiratory acidosis?

Does that fact that a drug comes packaged in a mildly acidic formulation mean that it will actually decrease the serum pH? If so, how much would 4ml (2g) of mag at a pH of 5.5 be expected to change the serum pH?

Is this affected at all by the IVF you are using, and the rate that it is running at?

If the patient has good renal function (most asthmatics probably do), how does that factor in?

What can we do for an asthmatic patient to decrease their metabolic demand and C02 production?

Do we actually use sodium bicarb in arrest?

Why not just give sodium bicarb with the mag?

 

[Carlos Danger]

double post

 

[StCEMT]

The biggest worry that I was taught, and it isn't anything to take lightly, is hypermagnesemia. Probably not something you're going to induce with 1-2 grams in a 50-100 NS bag, but definitely worth keeping in the back of your mind. Now riddle me this young padawon:

What's your reversal agent?*

*it's carried in every ALS kit/ gear/ system/ protocol that I know of.

Calcium, but admittedly I don't remember the science as to why. I will look it up once I get out of class.

You can trend ETC02. For every 10 change in PC02 you should get about 0.08 change in ph in the opposite direction. It will be an estimate unless you know the patients actual ETC02/PC02 gradient.

Good to know. I wish I had a way to see this first hand to solidify the idea.

 

[VentMonkey]

Good to know. I wish I had a way to see this first hand to solidify the idea.

Here's a quick tutorial with some relevance...

 

[Handsome Robb]

Here's a quick tutorial with some relevance...

ROME is the only reason I can understand ABGs.


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