Magnesium sulfate is a chemical compound with the formula MgSO4​. It is commonly known as Epsom salt, named after a bitter saline spring at Epsom in Surrey, England, where it was first obtained.

Magnesium sulfate acts as an osmotically active salt and is used orally as a laxative. It also acts on the smooth muscles of the bronchi & blood vessels and the myocardium, hence, it is used in the treatment of severe asthma, eclampsia, and preeclampsia in pregnant women, and in the treatment of torsade de pointes.

Magnesium sulfate Uses:

• Oral:
  • It is indicated as a laxative for the relief of occasional constipation (OTC labeling)
• Parenteral:
  • To treat and prevent hypomagnesemia
  • To treat and prevent seizures in severe preeclampsia or eclampsia, pediatric acute nephritis
  • For the treatment of cardiac arrhythmias (VT/VF) due to hypomagnesemia
• Topical:
  • It can be used as a soaking aid for minor cuts and bruises (OTC labeling)
• Off Label Use of Magnesium Sulfate in Adults:
  • Asthma especially in acute exacerbations or acute severe asthma
  • Arrhythmias: Torsades de pointes:
    • Polymorphic VT (with a pulse) associated with QT prolongation (torsades de pointes)
    • VF/pulseless VT associated with torsades de pointes

---

Magnesium sulfate Dose in Adults:

• When we talk about the dose of magnesium, we usually mean it as "magnesium sulfate" unless we specify otherwise.
• Measuring magnesium in the blood isn't the best way to tell if someone has enough magnesium in their body. This is because most of the magnesium in our body is inside our cells, not in the blood.
• Even after someone takes magnesium, their blood level might show normal for a short time. So, for people with healthy kidneys, it's good to aim for a slightly high blood magnesium level to make sure they really have enough.
• When we talk about the amount of magnesium, here's a breakdown:
  • 1 gram of magnesium sulfate has 98.6 milligrams of pure magnesium.
  • This 98.6 milligrams of pure magnesium can also be called 8.12 mEq or 4.06 mmol of magnesium.

 

Magnesium sulfate Dose in patients with an acute severe exacerbation of asthma (off-label):

• The recommended dose is 2 grams of magnesium sulfate.
• It's given through an intravenous (IV) injection, which means it's delivered directly into a vein.
• The IV infusion should take about 20 minutes to complete.
• Magnesium sulfate is used when someone's asthma is very severe, and it's not responding well to standard treatments.
• It can be considered after an hour of intensive conventional asthma therapy if the condition remains severe.

Magnesium sulfate Dose for Constipation (occasional):

• They can take magnesium sulfate, which you can use as a laxative.
• How to use it:
  • Dissolve 2 to 4 level teaspoons of the magnesium sulfate granules in a glass of water (about 8 ounces).
  • If needed, they can take it again 6 hours later.
• It's important not to take it more than 2 times in one day.

Magnesium sulfate Dose in Eclampsia and severe preeclampsia:

• Magnesium sulfate is used to treat severe cases of eclampsia and preeclampsia in pregnant women. Please note that treatment should be closely monitored, and doses need to be adjusted to prevent harm to the mother.
• The maximum recommended dose within a 24-hour period, according to product labeling, is 40 grams, but dosing can vary based on the specific treatment plan.
• There are two common ways to administer magnesium sulfate:
  • Intravenous (IV):
    • Start with a loading dose of 4 to 6 grams, which is given slowly over 20 to 30 minutes.
    • After the loading dose, continue with a continuous IV infusion of 1 to 2 grams per hour.
    • This IV infusion should continue for at least 24 hours after delivery.
  • Intramuscular (IM):
    • For women who cannot receive medication through a vein (IV), the initial dose is given as 10 grams.
    • This is administered as 5 grams into each buttock as an IM injection.
    • After the initial IM doses, an additional 5 grams can be given every 4 hours as needed.
• The manufacturer's labeling suggests starting with an initial total dose of 10 to 14 grams. This includes 4 grams through IV infusion and 4 to 5 grams as IM injections into each buttock. After this, the treatment can continue with either a continuous IV infusion or more IM injections as necessary.

Magnesium sulfate Dose for Hypomagnesemia:

• The treatment depends on how severe the deficiency is and the patient's overall health.
• If a patient is not showing symptoms and can take oral medication, it's better to give magnesium by mouth than through an injection.

Dosages:

• Mild Deficiency:
  • IM (injected into the muscle): 1 gram every 6 hours. This is given four times in total. The amount can change based on the blood test results for magnesium.
• Mild to Moderate Deficiency (blood test shows 1 to 1.5 mg/dL):
  • IV (injected into a vein): 1 to 4 grams, given slowly at a maximum rate of 1 gram per hour if the patient isn't showing symptoms. Never give more than 12 grams in 12 hours. After the first treatment, more doses might be needed over several days to replace the magnesium properly.
• Severe Deficiency:
  • IM: Up to 250 mg for every kilogram of the patient's weight, given within 4 hours.
  • IV:
    • If the blood test shows less than 1 mg/dL: 4 to 8 grams given slowly at a maximum rate of 1 gram per hour if no symptoms. But if there are symptoms, up to 4 grams can be given more quickly, over 4-5 minutes.
• For Overweight People:
  • If a person weighs more than 130% of their ideal body weight or has a body mass index (BMI) of 30 or higher, we need a special way to determine the dose.
  • For men: Adjusted weight is calculated using the formula: ([actual weight - ideal weight] x 0.3) + ideal weight.
  • For women: Adjusted weight is calculated using the formula: ([actual weight - ideal weight] x 0.25) + ideal weight.

These formulas help make sure the dose is safe and effective for overweight people.

Magnesium sulfate dose for the prevention of hypomagnesemia (parenteral nutrition supplementation):

• They should receive between 8 to 20 mEq of magnesium each day.

This recommendation comes from ASPEN (a nutrition therapy organization) based on their 2004 guidelines.

Soaking aid:

• Mix 2 cups of the granules into a gallon of warm water.
• If you prefer, you can wet a towel with this solution and place it on your skin like a moist wrap.

This can help to soothe various ailments or just for relaxation.

Magnesium sulfate Dose in patients with Torsades de pointes (off-label use):

For the medical condition called Torsades de Pointes (a specific kind of abnormal heart rhythm that's linked with a prolonged QT interval on an EKG):

• If the heart is still beating with an irregular rhythm (Polymorphic VT with a pulse):
  • Give 1 to 2 grams of magnesium sulfate through an IV.
  • This should be mixed in 50 to 100 mL of D5W (a type of sugar water) and given over 15 minutes. But the time can range from 5 to 60 minutes depending on the situation.
  • After that initial dose, you can continue with a continuous IV drip of magnesium at a rate of 0.5 to 1 gram per hour.
• If the heart has stopped beating or has a very unstable rhythm (VF or pulseless VT):
  • Quickly give 1 to 2 grams of magnesium sulfate through an IV or IO (intraosseous, which means into the bone marrow).
  • This dose should be diluted in 10 mL of D5W and given all at once, known as a bolus.

This use of magnesium sulfate is off-label, meaning it's not officially approved for this purpose but is recommended based on certain guidelines and studies.

---

Magnesium sulfate Dose in Children:

Note:

• 1,000 mg of magnesium sulfate contains about 98.7 mg of pure magnesium.
• This amount of pure magnesium is equal to 8.12 milliequivalents (mEq) of magnesium or 4.06 millimoles (mmol) of magnesium.

Also, when you check someone's blood for magnesium, it might not always show if they need more magnesium because most of it is inside their cells. So, for people with healthy kidneys, it's better to aim for consistently high-normal magnesium levels in the blood to make sure they are getting enough magnesium when needed.

Magnesium sulfate dose in Hypomagnesemia:

For treating low magnesium levels (Hypomagnesemia) in infants, children, and adolescents:

• The dosage depends on the patient's clinical condition and the results of their blood test for magnesium.

Using magnesium sulfate (expressed as magnesium sulfate):

• Through IV (intravenous) or IO (intraosseous, which means into the bone marrow), the initial dose is between 25 to 50 milligrams per kilogram of the child's weight.
• This is given every 6 hours for 2 to 3 doses.
• After these doses, it's essential to check the magnesium level in their blood.
• The maximum single dose should not exceed 2,000 milligrams.

Expressed as elemental magnesium (pure magnesium):

• Through IV, the initial dose is 2.5 to 5 milligrams per kilogram of the child's weight.
• This is given every 6 hours for 2 to 3 doses.

Magnesium sulfate dose in occasional Constipation:

Important: If you're using it as an over-the-counter remedy, don't use it for more than 7 days in a row unless a doctor or healthcare provider says it's okay.

• For children aged 6 to under 12:
  • Mix 1 to 2 level teaspoons of the magnesium sulfate granules into a glass of water (about 8 ounces).
  • If needed, they can take this mixture again 4 to 6 hours later.
  • But remember, no more than 2 doses in one day.
• For older children (12 and up) and teenagers:
  • Mix 2 to 4 level teaspoons of the granules into a glass of water (8 ounces).
  • If needed, they can have another dose 4 to 6 hours later.
  • But, again, don't take it more than 2 times in one day.

Maintenance dose of Magnesium sulfate in parenteral nutrition:

For babies and children weighing less than 50 kg (about 110 lbs):

• They should receive 0.3 to 0.5 milliequivalents (mEq) of magnesium for every kilogram they weigh each day.

For children weighing more than 50 kg and teenagers:

• They should receive between 10 to 30 milliequivalents (mEq) of magnesium every day.

This guidance comes from the ASPEN guidelines in 2004.

Magnesium sulfate Dose in children with Torsade de pointes or VF/pulseless VT associated with torsade de pointes:

For babies, children, and teenagers:

• They should receive 25 to 50 milligrams of magnesium sulfate for every kilogram they weigh as a single dose. This can be given through an IV (directly into a vein) or IO (into the bone marrow).
• No matter how much they weigh, they shouldn't receive more than 2,000 milligrams in a single dose.

This recommendation is based on the PALS guidelines from 2010.

Magnesium sulfate dose in Acute refractory status asthmaticus: Limited data available:

Given directly into a vein (IV):

• For babies, children, and teenagers:
  • They can receive between 25 to 75 milligrams of magnesium sulfate for every kilogram they weigh in a single dose.
  • The maximum single dose should not go over 2,000 milligrams.
  • This treatment is mainly recommended for those with severe asthma attacks, especially if they remain in a critical condition after 1 hour of standard treatments.
  • There are some mixed results on how effective this is. Some studies found it helpful, while others didn't notice a significant difference.

Given as a mist to breathe in (nebulization):

• Mild to Moderate Asthma:
  • For children aged 5 and above and teenagers:
    • They can inhale a mixture of a magnesium sulfate solution (2.5 mL) combined with albuterol (a common asthma medication). This is given as a single dose.
    • This combination seems to improve the effect of albuterol for some people.
• Moderate to Severe Asthma:
  • For children aged 2 and above and teenagers up to 16 years old:
    • A mix of magnesium sulfate with albuterol and another drug (ipratropium) is given. They get this treatment every 20 minutes, for a total of 3 doses.
    • In one large study, this treatment was found to help significantly, especially in those with the most severe symptoms.
    • Higher doses have been tried in teenagers, but adding magnesium didn't seem to make the treatment more effective in some studies.

---

Magnesium sulfate Pregnancy Category: D

• Magnesium, when given to pregnant women, can pass to the fetus and result in similar levels in both.
• If used continuously for more than 5-7 days, especially in high doses like those for preterm labor, it might lead to low calcium levels and bone issues in the baby.
• Doctors use magnesium injections to prevent seizures in mothers with severe preeclampsia or eclampsia.
• It can also protect babies from brain issues when birth is expected too early, before 32 weeks.
• Magnesium can delay birth by up to 48 hours to allow other treatments, but it's not the first choice for this purpose.
• Using it alongside some other drugs can raise risks for the mother.
• If a pregnant woman has heart or breathing issues after receiving magnesium, it might be due to an overdose.
• In emergencies, the treatments for pregnant women are the same as for other adults, and essential drugs shouldn't be avoided because of worries about harming the baby.

Magnesium sulfate use during breastfeeding:

• Magnesium is naturally found in breast milk.
• If a mother receives magnesium sulfate treatment for a condition like eclampsia while giving birth, the magnesium level in her breast milk might increase, but only for about a day after the treatment ends.
• In one study, this meant that the breastfeeding baby only got an extra 1.5 mg of magnesium on the day after the mom's treatment ended.
• The amount of magnesium in breast milk doesn't really change during the first year of breastfeeding and isn't affected by what the mother eats.
• The amount might vary between different mothers, but for each individual mother, it's usually consistent.
• Whether a woman is breastfeeding or not, her magnesium needs remain the same.
• Even though the manufacturer suggests being careful when giving magnesium sulfate to breastfeeding moms, using it to prevent seizures is generally thought to be safe for breastfeeding, as confirmed by the World Health Organization.

---

Magnesium sulfate dose in kidney disease:

For treating eclampsia or severe preeclampsia in patients with serious kidney problems:

• Start with a 4-to-6-gram dose given over 20 to 30 minutes.
• Then, give a continuous dose of 1 gram every hour for at least 24 hours after giving birth.
• According to the manufacturer, don't give more than 20 grams in a 2-day period.
• Since these patients have kidney problems, it's crucial to check magnesium levels regularly to ensure they're not getting too much.

For treating low magnesium levels in people with kidney problems:

• The dose should be cut in half.
• It's important to be cautious and frequently check for signs of too much magnesium in the blood. Close monitoring is necessary.

Dose in Liver disease:

• No dose adjustment required.

---

• Adverse effects on neuromuscular function may occur at lower concentrations in patients with neuromuscular disease (eg, myasthenia gravis).

Side effects of Magnesium sulfate:

• Cardiovascular:
  • Flushing (IV; dose related)
  • Hypotension (IV; rate related)
  • Vasodilation (IV; rate related)
• Endocrine & metabolic:
  • Hypermagnesemia

---

Contraindications to Magnesium sulfate:

You shouldn't use this magnesium sulfate treatment if:

• You're allergic to any part of it.
• You have heart block.
• You have damage to your heart muscle.
• You're going to give birth within the next 2 hours (for certain situations).

However, there are some things to note:

• Some guidelines say not to use magnesium sulfate if you're about to have a cesarean birth in the next 2 hours because it can interact with certain drugs used during surgery. But stopping it can increase the risk of seizures, so experts recommend continuing it even during delivery.
• Also, while some instructions say not to use it if you have heart block, it can be okay for people with mild heart block or those who have a device to help their heart beat regularly.

Warnings and precautions

Neuromuscular disease

• Be very careful when using magnesium sulfate in patients with conditions like myasthenia gravis or similar diseases.

Renal impairment

• Be careful when using magnesium sulfate because the body might not get rid of the magnesium properly, leading to too much magnesium in the system.

Magnesium sulfate: Drug Interaction

Risk Factor C (Monitor therapy)
Calcium Channel Blockers	May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers.
CNS Depressants	Magnesium Sulfate may enhance the CNS depressant effect of CNS Depressants.
Neuromuscular-Blocking Agents	Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents.
Ritodrine	May enhance the adverse/toxic effect of Magnesium Sulfate.
Risk Factor D (Consider therapy modification)
Alfacalcidol	May increase the serum concentration of Magnesium Salts.
Alpha-Lipoic Acid	Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. AlphaLipoic Acid may decrease the absorption of Magnesium Salts.
Bictegravir	Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended.
Bisphosphonate Derivatives	Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid.
Calcitriol (Systemic)	May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely.
Deferiprone	Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours.
Dolutegravir	Magnesium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts.
Doxercalciferol	May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely.
Eltrombopag	Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product.
Gabapentin	Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesiumcontaining antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used.
Levothyroxine	Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours.
Multivitamins/Fluoride (with ADE)	Magnesium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour.
Mycophenolate	Magnesium Salts may decrease the serum concentration of Mycophenolate. Management: Separate doses of mycophenolate and oral magnesium salts. Monitor for reduced effects of mycophenolate if taken concomitant with oral magnesium salts.
PenicillAMINE	Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour.
Phosphate Supplements	Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Exceptions: Sodium Glycerophosphate Pentahydrate.
Quinolones	Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Exceptions: LevoFLOXacin (Oral Inhalation).
Tetracyclines	Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Exceptions: Eravacycline.
Trientine	Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour.
Risk Factor X (Avoid combination)
Baloxavir Marboxil	Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil.
Calcium Polystyrene Sulfonate	Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of calcium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of calcium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives.
Raltegravir	Magnesium Salts may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction.
Sodium Polystyrene Sulfonate	Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of sodium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of sodium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives.

Monitoring parameters:

IV Treatment Monitoring:

• Speed: Watch out for quick doses.
• Heart: Monitor using an ECG.
• General Health:
  • Check vital signs.
  • Examine deep tendon reflexes.
• Blood Tests:
  • Check magnesium levels, especially if giving doses often or for a long time. This is very important for people with kidney problems.
  • Also, look at calcium and potassium levels.
  • Keep an eye on kidney function.

For Pregnant Women (Obstetrics):

• Mother's Health:
  • Monitor vital signs, oxygen levels, breathing, and deep tendon reflexes.
  • Keep track of her level of consciousness.
• Baby's Health:
  • Check the baby's heart rate.
  • Monitor the mother's uterine activity.
• Kidney and Magnesium:
  • Watch the mother's kidney function.
  • For those with kidney problems, check magnesium levels every 4 hours. If magnesium is high (>8 mEq/L), check every 2 hours.

---

How to administer Magnesium sulfate?

Ways to Administer:

• Can be given as an injection into the muscle (IM), directly into a vein (IV), or into the bone marrow (IO).

IM Administration:

• For adults: Use a solution with 25% or 50% concentration.
• For children: Dilute to a solution that has 20% concentration or less.
• For conditions like eclampsia or preeclampsia: Mixing with 2% lidocaine can help lessen pain from the injection.

IV or IO Administration:

• Dilute the solution to 20% or less concentration.
• Can be given directly as a push, through an IV drip, continuously, or into the bone marrow (IO).
• Important points:
  • When giving as an IV push, dilute and give slowly (not faster than 150 mg/minute).
  • Depending on the heart condition, the speed can vary from 5 to 60 minutes.
  • Be cautious: Giving too quickly can cause low blood pressure or even stop the heart in some patients.
  • For asthma patients: Give the dose over 20 to 60 minutes.

Rate for Regular Administration (e.g., for low magnesium levels):

• Up to half the dose might end up in the urine, so giving it slower can help the body retain more.
• Generally, don't give more than 1 gram per hour if the patient isn't showing symptoms.
• For smaller doses (less than 6 grams), give over 8-12 hours.
• For bigger doses, spread out over 24 hours.
• In urgent situations, like severe symptoms or conditions like preeclampsia, you might need to give up to 4 grams very quickly (in 4-5 minutes). Monitor these patients closely.

Oral Use:

• For constipation relief: Dissolve the dose in a glass (8 ounces) of water. You can add lemon juice to make it taste better.

Topical Use:

• Dissolve the granules to make a solution for soaking.
• For compresses: Soak a towel in the solution and place it on the skin.

---

Mechanism of action of Magnesium sulfate:

• Orally, magnesium helps with constipation by drawing water into the colon, making it swell and causing stronger contractions to push things along.
• Through an IV, magnesium reduces the nerve signals that control muscles and slows down the heart's electrical signals.
• Magnesium is also important for moving calcium, sodium, and potassium in and out of cells, and it helps keep cell membranes stable.
• When given through an IV, magnesium can improve lung function in asthma patients. It relaxes the muscles in the airways, making it easier to breathe, and it does this regardless of the amount of magnesium in the blood.

Anticonvulsant Effect:

• When given as an injection into the muscle (IM), it takes about 1 hour to work.
• Through an IV, it works immediately.
• The effect lasts for about 3 to 4 hours when given as an IM injection and only about 30 minutes when given through an IV.

Laxative Effect:

• When taken by mouth (oral), it can take anywhere from half an hour to 6 hours to start working.

Absorption:

• When taken orally, only about one-third of it is absorbed into the body, and it's a slow process.

Distribution:

• Most of it is stored in the bones (about 50% to 60%), while only a small amount is in the fluid outside of cells (1% to 2%).

Protein Binding:

• About 30% of it sticks to a protein called albumin in the blood.

Excretion:

• It's removed from the body through urine as magnesium.
• If the body doesn't absorb it, it may end up in the feces.

---

International Brand Names of Magnesium sulfate:

• Epsom Salt
• GoodSense Epsom Salt
• Cholal modificado
• Magnesii Sulfurici
• Kiddi Pharmaton
• Magnesii Sulfas
• Magnesii Sulfas Siccatus
• Magnesium Sulfuricum
• Magunesin
• Vivioptal Junior

---

Magnesium sulfate Brand Names in Pakistan:

Magnesium Sulphate Injection 1 g/ml in Pakistan
Mag-S	Mass Pharma (Private) Limited

Magnesium Sulphate Injection 500 mg/ml in Pakistan
Magnesium Sulphate	Zafa Pharmaceutical Laboratories (Pvt) Ltd.