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CHAPTER 18 Gastrointestinal System

GI Osmotic: Laxative/Antacid, Anticonvulsant, Electrolyte

Use

Treatment/prevention
of hypomagnesemia.
Treatment of hypertension,
torsade de pointes,
encephalopathy, seizures
associated with acute
nephritis, constipation,
hyperacidity.

Example

How it works

Half-life:
UK

Magnesium chloride
Magnesium citrate
(Citrate of Magnesia)
Magnesium hydroxide
(MOM)
Magnesium oxide
(Mag-ox)
Magnesium protein
complex (Mg-PLUS)
Magnesium sulfate
(Epsom salt, magnesium
sulfate injection)

Onset:
Route
dependent

Route:
PO/IM/IV

Peaks:
Route
dependent

Pregnancy
category: C

Duration:
Route
dependent

Pharmacokinetic:
Antacid, laxative:
minimal absorption
through intestine.
Absorbed dose
primarily excreted
in urine; Systemic:
Widely distributed;
primarily excreted
in urine.

Antacid: Acts in stomach to neutralize gastric acid, increase pH.

Laxative: Osmotic effect primarily in small intestine. Draws
water into intestinal lumen, produces distention, promotes
peristalsis, bowel evacuation.

Systemic (dietary supplement, replacement): Found primarily

in intracellular fluids. Essential for enzyme activity, nerve
conduction, and muscle contraction.

Anticonvulsant: Blocks neuromuscular transmission, amount

of acetylcholine released at motor end plate, producing
seizure control.

CHAPTER 18 Gastrointestinal System

GI Osmotic: Laxative/Antacid, Anticonvulsant, Electrolyte (continued)

Adult dose

Hypomagnesemia (magnesium sulfate):

IM/IV: 1 g q6 h for 4 doses

PO: 3 g q6 h for 4 doses
Hypertention, seizures (magnesium sulfate)

IM/IV: 1 g q6 h for 4 doses as needed

Torsade de pointes (magnesium sulfate)

UVL 2550 mg/kg/dose; maximum 2 g

Laxative

Magnesium citrate: PO: 150300 mL

Magnesium hydroxide: PO: 3060 mL/day
Antacid

Magnesium hydroxide: Note: Up to 4 times/day; PO: (tablet):

6221244 mg/dose; (liquid concentrate: 2.57.5 mL/dose;
(liquid): 515 mL/dose
Before administration

Assess if patient is sensitive to magnesium.

Antacid: Assess GI pain (duration, location, time of occurrence,
relief with food, or caused by food or alcohol, constant or
sporadic, worsened when lying down or bending over).

Laxative: Assess color, amount, consistency of stool. Assess

bowel habits (usual pattern), bowel sound for peristalsis.

Assess patient for any abdominal pain, weight loss, nausea,

vomiting, history of recent abdominal surgery.

Systemic: Assess renal function, magnesium level.

Administration

PO (antacid): Shake suspension well before use; chewable

tablets should be chewed thoroughly before swallowing and
follow with full glass of water.

PO (laxative): Drink full glass of liquid (8 oz) with each dose

(prevents dehydration); Flavor may be improved by following
with fruit juice or citrus carbonate beverage; refrigerate citrate
of magnesia (retains potency, palatability).

IM: Use 250 mg/mL (25%) or 500 mg/mL (50%) magnesium

sulfate concentration.

IV: Store at room temperature; must dilute (do not exceed

20 mg/mL concentration); do not exceed magnesium sulfate
concentration 200 mg/mL (20%); do not exceed IV infusion
rate of 150 mg/min.

CHAPTER 18 Gastrointestinal System

GI Osmotic: Laxative/Antacid, Anticonvulsant, Electrolyte (continued)

After administration

Antacid: Assess for relief of gastric distress; monitor renal

function (especially if dosing is long term or frequent).

Laxative: Monitor stools for diarrhea or constipation; maintain

adequate fluid intake.

Systemic: Monitor renal function, magnesium levels, EKG

for cardiac function; test patellar reflex or knee jerk reflexes
before giving repeat parenteral doses (used as indication of
CNS depression; suppressed reflex may be sign of impending
respiratory arrest). Patellar reflex must be present, respiratory
rate >16/min before each parenteral dose. Provide seizure
precautions.
Contraindications

Antacids: Severe renal impairment; appendicitis or symptoms

of appendicitis, ileostomy, intestinal obstruction.

Laxatives: Appendicitis, undiagnosed rectal bleeding, CHF,

intestinal obstruction, hypersensitivity, colostomy, ileostomy.

Systemic: Heart block, myocardial damage, renal failure.

Cautions: Safety in children <6 years not known; Antacids:
Undiagnosed gastrointestinal or rectal bleeding, ulcerative
colitis, colostomy, diverticulitis, chronic diarrhea. Laxative:
Diabetes mellitus or patients on low-salt diet (some products
contain sugar: sodium). Systemic: Severe renal impairment.
Side effects/
adverse reaction

Frequent: Antacid: Chalky taste, diarrhea, laxative effect.

Occasional: Antacid: Nausea, vomiting, stomach cramps.
Antacid, laxative; prolonged use of large dose with renal
impairment may cause increased magnesium (dizziness,
irregular heartbeat, mental changes, tiredness, weakness);
laxative: cramping, diarrhea, increased thirst, gas. Systemic:
reduced respiratory rate, decreased reflexes, flushing,
hypotension, decreased heart rate.
Adverse/toxic: Antacid, laxative: None significant. Systemic: May
produce prolonged PR interval, widening of QRS intervals; may
cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest. Antidote: 1020 mL 10% calcium gluconate (510 mEq of calcium).

CHAPTER 18 Gastrointestinal System

GI Osmotic: Laxative/Antacid, Anticonvulsant, Electrolyte (continued)

Patient education

Antacid:

Give at least 2 hours apart from other medications.

Do not take >2 weeks unless directed by physician.
For peptic ulcer take 1 and 3 hours after meals and at bedtime
for 46 weeks.

Chew tablets thoroughly followed with glass of water.

Shake suspensions well.
Repeat dosing/large doses may have laxative effect.
Laxative:

Drink full glass (8 oz liquid) to aid stool softening.

Use only for short term.
Do not use if abdominal pain, vomiting, nausea are present.
Systemic:

Inform health care provider of any signs of hypermagnesemia

(confusion, irregular heartbeat, cramping, unusual tiredness or
weakness, lightheadedness, or dizziness).