Clinical indications of a safe dosage regimen include presence of patellar reflex (knee jerk) and absence of respiratory depression (approximately 16 breaths or more per minute) serum magnesium concentrations usually sufficient to control convulsions range from 3 to 6 mg per 100 mL (2.5 to 5 mEq per liter).Monitor clinical signs of magnesium toxicity (for example, facial edema, diminished strength of deep tendon reflexes, respiratory depression) and magnesium concentrations during infusions of magnesium sulfate in 5% dextrose injection.Patients receiving magnesium sulfate in 5% dextrose injection are at risk for magnesium toxicity including respiratory depression, acute renal failure, and rarely, pulmonary edema.If myasthenic crisis suspected, discontinue use of magnesium sulfate in 5% dextrose injection immediately secure patient's airway consider intensive care unit admission and elective intubation, if respiratory failure is anticipated once airway is secure, confirm the diagnosis therapies include plasmapheresis and plasma exchange or intravenous immunoglobulin (IVIG) and immunomodulating therapy in addition to high-dose glucocorticoids.Symptoms of myasthenic crisis may include difficulty swallowing, ptosis, facial droop, weakness, and/or difficulty breathing that may require intubation.Use of magnesium sulfate in patients with underlying myasthenia gravis can precipitate a myasthenic crisis myasthenic crisis is a life-threatening condition characterized by neuromuscular respiratory failure.Magnesium sulfate in 5% dextrose injection is contraindicated in patients with known myasthenia gravis.Magnesium sulfate in 5% dextrose injection contains aluminum that may be toxic (magnesium sulfate in 5% dextrose injection contains 4 to 5 mcg/kg/day, accumulate aluminum at concentrations associated with central nervous system and bone toxicity tissue loading may occur at even lower rates of administration.

Solutions containing dextrose should be used with caution in patients with known prediabetes or diabetes mellitus given the risk of elevated blood glucoseĭo not use in 5% dextrose Injection with unapproved tocolytics (eg, beta-adrenergic agents such as terbutaline, or with calcium channel blockers such as nifedipine) serious adverse events including pulmonary edema and hypotension have occurred Aluminum toxicity Serum levels poorly correlate to body stores

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