Monday, July 2, 2018

Torsade de Pointes

PulmCrit - July 2, 2018 - By Josh Farkas

..."Summary: The Bullet
  • Magnesium is the naloxone of TdP: it works great temporarily, but TdP may recur after magnesium is excreted by the kidneys.
  • After an episode of TdP, the optimal magnesium level seems to be ~3.5-5 mg/dL (not the traditional target of Mg >2 mg/dL).
  • Initiation of a protocolized magnesium infusion immediately following the first episode of TdP may prevent recurrence and thereby avoid complications (e.g. cardiac arrest, rib fractures). This is part of textbook management of TdP, but it is underutilized because the nuts & bolts of running an infusion are unclear.
  • A standardized, evidence-based magnesium infusion protocol may increase the ease and safety of magnesium infusions. This translates magnesium infusion into something which is reproducibly achievable at the bedside.
  • Patients with impaired renal function (GFR<30 ml/min) may be treated with repeated measurement of magnesium levels and PRN boluses, with a target magnesium level of 3.5-5 mg/dL."