# A client on PPI for 1 year has Mg 1.2 mEq/L and is ordered magnesium sulfate 2 g IV. Which is the priority assessment?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client on PPI for 1 year has Mg 1.2 mEq/L and is ordered magnesium sulfate 2 g IV. Which is the priority assessment?

## Option

1. Liver function studies including ALT, AST, and bilirubin to assess for drug-induced hepatic injury from long-term PPI use
2. Deep tendon reflexes, respiratory rate, BP, urine output, and ECG — too-rapid infusion causes hypotension and DTR loss **✔ Correct answer**
3. Visual acuity and extraocular movements to detect nystagmus or diplopia from rising magnesium levels
4. Capillary blood glucose every 4 hours because magnesium potentiates insulin action, risking hypoglycemia

**Correct answer: 2**

## Explanation

Correct (2): IV Mg replacement requires monitoring DTRs, RR, BP, urine output ≥30 mL/hr, ECG. Rapid infusion or excessive dose causes hypotension, DTR loss, respiratory depression — antidote is calcium gluconate. (1,3,4) Not Mg-related.

## In-depth explanation

Memory Tip Mg sulfate IV monitoring = "DTR·RR·BP·UO" same as OB preeclampsia. Slow infusion ≤1 g/hr in non-eclampsia replacement.

## Clinical scenario

Scenario 58-year-old female on PPI 1 year, Mg 1.2 mEq/L, prescribed magnesium sulfate 2 g IV over 1 hour.

## Key concepts

- **Hypomagnesemia** — Causes: PPI, diuretics, alcohol, GI losses; symptoms tetany, tremor, arrhythmia.
- **Magnesium IV protocol** — 1-2 g IV over 1 hour for mild; ≤1 g/hr; calcium gluconate antidote.
- **Mg replacement vs OB protocol** — Replacement: 1-2 g/hr. OB preeclampsia: 4-6 g loading + 2 g/hr.

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