Medical uses of magnesium sulfate

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Magnesium sulfate
Magnesium sulfate.JPG
Magnesium sulfate heptahydrate
Clinical data
Trade names Epsom salt, others
AHFS/Drugs.com Monograph
Routes of
administration 		IV, IM, by mouth, topical
ATC code
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEBI
ChEMBL
Chemical and physical data
Formula MgSO4 – 7H2O
Molar mass 120.366
3D model (JSmol)
  • [O-]S(=O)(=O)[O-].[Mg+2]
  • InChI=1S/Mg.H2O4S/c;1-5(2,3)4/h;(H2,1,2,3,4)/q+2;/p-2
  • Key:CSNNHWWHGAXBCP-UHFFFAOYSA-L

Magnesium sulfate as a medication is used to treat and prevent low blood magnesium and seizures in women with eclampsia. [1] It is also used in the treatment of torsades de pointes, severe asthma exacerbations, constipation, and barium poisoning. [1] [2] It is given by injection into a vein or muscle as well as by mouth. [1] [2] As epsom salts, it is also used for mineral baths. [3]

Contents

Common side effects include low blood pressure, skin flushing, and low blood calcium. [1] Other side effects may include vomiting, muscle weakness, and decreased breathing. [4] While there is evidence that use during pregnancy may harm the baby, the benefits in certain conditions are greater than the risks. [5] Its use during breastfeeding is deemed to be safe. [5] The way it works is not fully understood, but is believed to involve depressing the action of neurons. [1]

Magnesium sulfate came into medical use at least as early as 1618. [6] It is on the World Health Organization's List of Essential Medicines. [7] [8]

Forms

Magnesium sulfate is available as magnesium sulfate dihydrate, [9] magnesium sulfate heptahydrate, [2] [10] and magnesium sulfate monohydrate. [11]

Heptahydrate

The World Health Organization recommends magnesium sulfate heptahydrate for medical injection. [12]

External uses

Bath salts

Magnesium sulfate is used in bath salts, especially for foot baths to soothe sore feet. The reason for the inclusion of the salt is partially cosmetic: the increase in ionic strength prevents some of the temporary skin wrinkling (partial maceration) which would occur with plain water baths.

Epsom salt baths have been claimed to also soothe and hasten recovery of muscle pain, soreness, or injury. However, these claims have not been scientifically confirmed. [13] The solubility of magnesium sulfate water is inhibited by lipids in lotions resulting in variable absorption rates when applied to the skin. Temperature and concentration are also factors. [14]

Research

Research on topical magnesium (for example epsom salt baths) is limited. [15]

Isolation tanks

Magnesium sulfate is commonly used in flotation therapy to prepare the concentrated solutions that fill the isolation tanks. Its high solubility in water yields baths with high specific gravity that make the body more buoyant. Its negligible toxicity is an important asset in that application.

Mineral waters

Magnesium and sulfate ions are naturally present in some mineral waters. [16]

Drawing paste

In the UK, a medication containing magnesium sulfate, called "drawing paste", is claimed to be useful for small boils or localised infections, [17] and removing splinters. [18] The standard British Pharmacopoeia composition is dried magnesium sulfate 47.76% (by mass), phenol 0.49%, and glycerol to balance. [17]

Internal uses

Magnesium sulfate intravenous solution Magnesium Sulfate IV 2.jpg
Magnesium sulfate intravenous solution

Magnesium sulfate can be administered internally by oral, respiratory, intravenous, or intrathecal routes.

Magnesium deficiency

Injected magnesium sulfate is used as a replacement therapy for magnesium deficiency. [19]

Orally administered magnesium sulfate is laxative and thus the magnesium is not well absorbed.

Arrhythmia

Magnesium sulfate may be used as an antiarrhythmic agent for torsades de pointes in cardiac arrest under the ECC guidelines and for managing quinidine-induced arrhythmias. [20]

Asthma

Magnesium sulfate may be used as bronchodilator after beta-agonist and anticholinergic agents have been tried, e.g. in severe exacerbations of asthma, [21] The salt can be administered by nebulization [21] or by intravenous injection.

Eclampsia

Magnesium sulfate is effective in decreasing the risk that pre-eclampsia progresses to eclampsia. [22] Intravenous magnesium sulfate is used to prevent and treat seizures of eclampsia. It reduces the systolic blood pressure but does not alter the diastolic blood pressure, so the blood perfusion to the fetus is not compromised. It is also commonly used for eclampsia where compared to diazepam or phenytoin it results in better outcomes. [23] [24]

Early delivery

Magnesium sulfate was once used as a tocolytic, [25] [26] but meta-analyses have failed to support it as an anti-contraction medication. [27] [28] Usage for prolonged periods (more than five to seven days) may result in health problems for the baby. [29]

In those at risk of an early delivery, magnesium sulfate appears to decrease the risk of cerebral palsy. [30] [31] It is unclear if it helps those who are born at term. [32] Guidelines for the use of magnesium sulfate in mothers at risk of preterm labour are not strongly adhered to. [33]

Barium chloride poisoning

Magnesium sulfate is used to treat barium chloride poisoning, [34] where sulfate binds to barium to form insoluble barium sulfate.

Lead poisoning

Magnesium sulfate was historically used as a treatment for lead poisoning. Prior to the development of chelation therapy, cases of accidental lead ingestion were often immediately treated with magnesium sulfate, which would cause the lead to be precipitated out and, with a high enough dose, literally purged from the digestive system as insoluble lead(II) sulfate. [35] [36] In this application, magnesium sulfate saw particular use in veterinary medicine of the early-to-mid 20th century; Epsom salt was already available on many farms for agricultural purposes, and it was often prescribed in the treatment of farm animals which inadvertently ingested lead. [37] [38]

Adjuvant to local anesthetics

Magnesium sulfate can be administered intrathecally with opioids to prolong their analgesic duration. [39]

Research

Magnesium sulfate has been used as an experimental treatment of Irukandji syndrome caused by envenomation by certain species of Irukandji jellyfish, but the efficacy of this treatment remains unproven. [40]

Safety

An abnormally elevated plasma concentration of magnesium is called hypermagnesemia.

See also

Related Research Articles

<span class="mw-page-title-main">Magnesium</span> Chemical element, symbol Mg and atomic number 12

Magnesium is a chemical element; it has symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals it occurs naturally only in combination with other elements and it almost always has an oxidation state of +2. It reacts readily with air to form a thin passivation coating of magnesium oxide that inhibits further corrosion of the metal. The free metal burns with a brilliant-white light. The metal is obtained mainly by electrolysis of magnesium salts obtained from brine. It is less dense than aluminium and is used primarily as a component in strong and lightweight alloys that contain aluminium.

<span class="mw-page-title-main">Asthma</span> Long-term inflammatory disease of the airways of the lungs

Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.

<span class="mw-page-title-main">Iron(II) sulfate</span> Chemical compound

Iron(II) sulfate (British English: iron(II) sulphate) or ferrous sulfate denotes a range of salts with the formula Fe SO4·xH2O. These compounds exist most commonly as the heptahydrate (x = 7) but several values for x are known. The hydrated form is used medically to treat or prevent iron deficiency, and also for industrial applications. Known since ancient times as copperas and as green vitriol (vitriol is an archaic name for sulfate), the blue-green heptahydrate (hydrate with 7 molecules of water) is the most common form of this material. All the iron(II) sulfates dissolve in water to give the same aquo complex [Fe(H2O)6]2+, which has octahedral molecular geometry and is paramagnetic. The name copperas dates from times when the copper(II) sulfate was known as blue copperas, and perhaps in analogy, iron(II) and zinc sulfate were known respectively as green and white copperas.

<span class="mw-page-title-main">Magnesium sulfate</span> Chemical compound with formula MgSO4

Magnesium sulfate or magnesium sulphate is a chemical compound, a salt with the formula MgSO4, consisting of magnesium cations Mg2+ (20.19% by mass) and sulfate anions SO2−4. It is a white crystalline solid, soluble in water but not in ethanol.

<span class="mw-page-title-main">Eclampsia</span> Pre-eclampsia characterized by the presence of seizures

Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in the urine or other organ dysfunction, and edema. If left untreated, pre-eclampsia can result in long-term consequences for the mother, namely increased risk of cardiovascular diseases and associated complications. In more severe cases, it may be fatal for both the mother and the fetus. The diagnostic criteria for pre-eclampsia is high blood pressure occurring after 20 weeks gestation or during the second half of pregnancy. Most often it occurs during the 3rd trimester of pregnancy and may occur before, during, or after delivery. The seizures are of the tonic–clonic type and typically last about a minute. Following the seizure, there is either a period of confusion or coma. Other complications include aspiration pneumonia, cerebral hemorrhage, kidney failure, pulmonary edema, HELLP syndrome, coagulopathy, placental abruption and cardiac arrest.

<span class="mw-page-title-main">Pre-eclampsia</span> Hypertension occurring during pregnancy

Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. Pre-eclampsia increases the risk of undesirable as well as lethal outcomes for both the mother and the fetus including preterm labor. If left untreated, it may result in seizures at which point it is known as eclampsia.

<span class="mw-page-title-main">Preterm birth</span> Birth at less than a specified gestational age

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 34 weeks, late preterm birth is between 34 and 36 weeks' gestation. These babies are also known as premature babies or colloquially preemies or premmies. Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or the leaking of fluid from the vagina before 37 weeks. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and problems with their vision. The earlier a baby is born, the greater these risks will be.

<span class="mw-page-title-main">Epsomite</span> Sulfate mineral

Epsomite, Epsom salt, or magnesium sulfate heptahydrate, is a hydrous magnesium sulfate mineral with formula MgSO4·7H2O.

<span class="mw-page-title-main">Barium sulfate</span> Inorganic chemical compound

Barium sulfate (or sulphate) is the inorganic compound with the chemical formula BaSO4. It is a white crystalline solid that is odorless and insoluble in water. It occurs as the mineral barite, which is the main commercial source of barium and materials prepared from it. Its opaque white appearance and its high density are exploited in its main applications.

<span class="mw-page-title-main">Chlorhexidine</span> Disinfectant and antiseptic

Chlorhexidine is a disinfectant and antiseptic with the molecular formula C22H30Cl2N10, which is used for skin disinfection before surgery and to sterilize surgical instruments. It is also used for cleaning wounds, preventing dental plaque, treating yeast infections of the mouth, and to keep urinary catheters from blocking. It is used as a liquid or a powder. It is commonly used in salt form, either the gluconate or the acetate.

Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment.

<span class="mw-page-title-main">Bleomycin</span> Glycopeptide antibiotic used to treat various cancers

Bleomycin is a medication used to treat cancer. This includes Hodgkin's lymphoma, non-Hodgkin's lymphoma, testicular cancer, ovarian cancer, and cervical cancer among others. Typically used with other cancer medications, it can be given intravenously, by injection into a muscle or under the skin. It may also be administered inside the chest to help prevent the recurrence of a pleural effusion due to cancer; however talc is better for this.

<span class="mw-page-title-main">Barium chloride</span> Chemical compound

Barium chloride is an inorganic compound with the formula BaCl2. It is one of the most common water-soluble salts of barium. Like most other water-soluble barium salts, it is a white powder, highly toxic, and imparts a yellow-green coloration to a flame. It is also hygroscopic, converting to the dihydrate BaCl2·2H2O, which are colourless crystals with a bitter salty taste. It has limited use in the laboratory and industry.

<span class="mw-page-title-main">Budesonide/formoterol</span> Management of asthma & chronic obstructive pulmonary disease

Budesonide/formoterol, sold under the brand name Symbicort among others, is a fixed-dose combination medication used in the management of asthma or chronic obstructive pulmonary disease (COPD). It contains budesonide, a steroid and formoterol, a long-acting β2-agonist (LABA). The product monograph does not support its use for sudden worsening or treatment of active bronchospasm. However, a 2020 review of the literature does support such use. It is used by breathing in the medication.

Tocolytics are medications used to suppress premature labor. Preterm birth accounts for 70% of neonatal deaths. Therefore, tocolytic therapy is provided when delivery would result in premature birth, postponing delivery long enough for the administration of glucocorticoids, which accelerate fetal lung maturity but may require one to two days to take effect.

Magnesium deficiency is an electrolyte disturbance in which there is a low level of magnesium in the body. It can result in multiple symptoms. Symptoms include tremor, poor coordination, muscle spasms, loss of appetite, personality changes, and nystagmus. Complications may include seizures or cardiac arrest such as from torsade de pointes. Those with low magnesium often have low potassium.

<span class="mw-page-title-main">Iron supplement</span> Iron formulation used to prevent or treat iron deficiency anemia

Iron supplements, also known as iron salts and iron pills, are a number of iron formulations used to treat and prevent iron deficiency including iron deficiency anemia. For prevention they are only recommended in those with poor absorption, heavy menstrual periods, pregnancy, hemodialysis, or a diet low in iron. Prevention may also be used in low birth weight babies. They are taken by mouth, injection into a vein, or injection into a muscle. While benefits may be seen in days, up to two months may be required until iron levels return to normal.

<span class="mw-page-title-main">Calcium gluconate</span> Chemical compound

Calcium gluconate is the calcium salt of gluconic acid and is used as a mineral supplement and medication. As a medication it is used by injection into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity. Supplementation is generally only required when there is not enough calcium in the diet. Supplementation may be done to treat or prevent osteoporosis or rickets. It can also be taken by mouth but is not recommended for injection into a muscle.

Magnesium salts are available as a medication in a number of formulations. They are used to treat magnesium deficiency, low blood magnesium, eclampsia, and several other conditions. Magnesium is an essential nutrient.

<span class="mw-page-title-main">Calcium supplement</span> Dietary mineral supplement

Calcium supplements are salts of calcium used in a number of conditions. Supplementation is generally only required when there is not enough calcium in the diet. By mouth they are used to treat and prevent low blood calcium, osteoporosis, and rickets. By injection into a vein they are used for low blood calcium that is resulting in muscle spasms and for high blood potassium or magnesium toxicity.

References

  1. 1 2 3 4 5 "Magnesium Sulfate". The American Society of Health-System Pharmacists. Archived from the original on 21 May 2016. Retrieved 8 January 2017.
  2. 1 2 3 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 696. ISBN   9780857111562.
  3. ↑ Kogel JE, Trivedi NC, Barker JM, Krukowski ST (2006). "Magnesium Minerals and Compounds". Industrial Minerals & Rocks: Commodities, Markets, and Uses. SME. p. 625. ISBN   9780873352338. Archived from the original on 18 September 2017.
  4. ↑ World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 75. hdl: 10665/44053 . ISBN   9789241547659.
  5. 1 2 "Magnesium sulfate Use During Pregnancy". Drugs.com. Archived from the original on 2 July 2017.
  6. ↑ Willett E (2006). Magnesium. The Rosen Publishing Group. p. 5. ISBN   9781404210073. Archived from the original on 18 September 2017.
  7. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  8. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
  9. ↑ "Magnesium sulfate dihydrate". DrugBank Online. Retrieved 27 March 2022.
  10. ↑ "Magnesium sulfate heptahydrate". DrugBank Online. Retrieved 27 March 2022.
  11. ↑ "Magnesium sulfate monohydrate". DrugBank Online. Retrieved 27 March 2022.
  12. ↑ "WHO-PQ RECOMMENDED PATIENT INFORMATION LEAFLET" (PDF). June 2020.
  13. ↑ Ingraham P. "Does Epsom Salt Work? The science of Epsom salt bathing for recovery from muscle pain, soreness, or injury". Pain Science. Archived from the original on 10 September 2016. Retrieved 29 August 2016.
  14. ↑ "Does Epsom Salt Work?". www.PainScience.com. Retrieved 5 May 2018.
  15. ↑ Rath L. "Why Take an Epsom Salts Bath?". WebMD.
  16. ↑ "Bath – Hot Springs". Archived from the original on 27 October 2007. Retrieved 16 October 2016.
  17. 1 2 "Boots Magnesium Sulfate Paste B.P. – Patient Information Leaflet (PIL) – (eMC)". www.medicines.org.uk. Retrieved 14 April 2018.
  18. ↑ Ryan. "Removing a splinter with Magnesium Sulphate". TipKing.
  19. ↑ "Pharmaceutical Information – Magnesium Sulfate". RxMed. Archived from the original on 3 April 2009. Retrieved 6 July 2009.
  20. ↑ "CPR and First Aid: Antiarrhythmic Drugs During and Immediately After Cardiac Arrest (section)". American Heart Association. Retrieved 29 August 2016. Previous ACLS guidelines addressed the use of magnesium in cardiac arrest with polymorphic ventricular tachycardia (ie, torsades de pointes) or suspected hypomagnesemia, and this has not been reevaluated in the 2015 Guidelines Update. These previous guidelines recommended defibrillation for termination of polymorphic VT (ie, torsades de pointes), followed by consideration of intravenous magnesium sulfate when secondary to a long QT interval.
  21. 1 2 Blitz M, Blitz S, Hughes R, Diner B, Beasley R, Knopp J, Rowe BH (July 2005). "Aerosolized magnesium sulfate for acute asthma: a systematic review". Chest. 128 (1): 337–344. doi:10.1378/chest.128.1.337. PMID   16002955..
  22. ↑ Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D (November 2010). "Magnesium sulphate and other anticonvulsants for women with pre-eclampsia". The Cochrane Database of Systematic Reviews. 2010 (11): CD000025. doi:10.1002/14651858.CD000025.pub2. PMC   7061250 . PMID   21069663.
  23. ↑ Duley L, Henderson-Smart DJ, Walker GJ, Chou D (December 2010). "Magnesium sulphate versus diazepam for eclampsia". The Cochrane Database of Systematic Reviews. 2010 (12): CD000127. doi:10.1002/14651858.CD000127.pub2. PMC   7045443 . PMID   21154341.
  24. ↑ Duley L, Henderson-Smart DJ, Chou D (October 2010). "Magnesium sulphate versus phenytoin for eclampsia". The Cochrane Database of Systematic Reviews (10): CD000128. doi:10.1002/14651858.CD000128.pub2. PMID   20927719.
  25. ↑ "Magnesium sulfate for preterm labor". Webmd.com. 19 January 2007. Archived from the original on 24 June 2009. Retrieved 6 July 2009.
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  27. ↑ Simhan HN, Caritis SN (August 2007). "Prevention of preterm delivery". The New England Journal of Medicine. 357 (5): 477–487. doi:10.1056/NEJMra050435. PMID   17671256.
  28. ↑ Grimes DA, Nanda K (October 2006). "Magnesium sulfate tocolysis: time to quit". Obstetrics and Gynecology. 108 (4): 986–989. doi:10.1097/01.AOG.0000236445.18265.93. PMID   17012463. S2CID   30014199.
  29. ↑ "Magnesium Sulfate: Drug Safety Communication – Recommendation Against Prolonged Use in Pre-term Labor". FDA. Archived from the original on 3 June 2013. Retrieved 2 June 2013.
  30. ↑ Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D (January 2009). "Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus". The Cochrane Database of Systematic Reviews (1): CD004661. doi:10.1002/14651858.CD004661.pub3. PMID   19160238.
  31. ↑ Wolf HT, Hegaard HK, Greisen G, Huusom L, Hedegaard M (February 2012). "Treatment with magnesium sulphate in pre-term birth: a systematic review and meta-analysis of observational studies". Journal of Obstetrics and Gynaecology. 32 (2): 135–140. doi:10.3109/01443615.2011.638999. PMID   22296422. S2CID   24012925.
  32. ↑ Nguyen TM, Crowther CA, Wilkinson D, Bain E (February 2013). "Magnesium sulphate for women at term for neuroprotection of the fetus". The Cochrane Database of Systematic Reviews. 2 (2): CD009395. doi:10.1002/14651858.cd009395.pub2. PMID   23450601.
  33. ↑ Shih ST, Tonmukayakul U, Imms C, Reddihough D, Graham HK, Cox L, Carter R (June 2018). "Economic evaluation and cost of interventions for cerebral palsy: a systematic review". Developmental Medicine and Child Neurology. 60 (6): 543–558. doi: 10.1111/dmcn.13653 . hdl: 10536/DRO/DU:30106090 . PMID   29319155.
  34. ↑ "BARIUM CHLORIDE DIHYDRATE 4. First Aid Measures". Jtbaker.com. Archived from the original on 9 July 2012. Retrieved 6 July 2009.{{cite web}}: CS1 maint: unfit URL (link)
  35. ↑ Wood HC (1877). A Treatise on Therapeutics, Comprising Materia Medica and Toxicology, with Especial Reference to the Application of the Physiological Action of Drugs to Clinical Medicine. Philadelphia: J. B. Lippincott & Co. p. 34. The treatment of acute lead-poisoning consists in the evacuation of the stomach, if necessary, the exhibition of the sulphate of sodium or of magnesium, and the meeting of the indications as they arrive. The Epsom and Glauber's salts act as chemical antidotes, by precipitating the insoluble sulphate of lead, and also, if in excess, empty the bowel of the compound formed.
  36. ↑ Rangan C (27 January 2016). Lead and Mercury (PDF). Children's Environmental Health Symposium San Diego 2016: Protecting Children's Environmental Health in the U.S.-Mexico Border Region. San Diego, CA: Environmental Protection Agency . Retrieved 2 August 2020.
  37. ↑ Barker CA (January 1945). "Experience with Lead Poisoning". Canadian Journal of Comparative Medicine and Veterinary Science. 9 (1): 6–8. PMC   1660962 . PMID   17648099. Udall (1) suggests sodium citrate as of some value together with Epsom salts which will bring about a precipitation of the lead in the form of an insoluble compound. Nelson (3) reported a case that survived following the use of a 20% magnesium sulphate solution intravenously, subcutaneously and orally. McIntosh (5) has suggested that purgative doses of Epsom salts may be effective in combining with the lead and overcoming the toxicity.
  38. ↑ Herriot J (1972). All Creatures Great and Small. New York: St. Martin's Press. p. 157. ISBN   0-312-08498-6. The specific antidotes to metal poisoning had not been discovered and the only thing which sometimes did a bit of good was magnesium sulphate which caused the precipitation of insoluble lead sulphate. The homely term for magnesium sulphate is, of course, epsom salts.
  39. ↑ Nath MP, Garg R, Talukdar T, Choudhary D, Chakrabarty A (July 2012). "To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial". Saudi Journal of Anaesthesia. 6 (3): 254–258. doi: 10.4103/1658-354x.101217 . PMC   3498664 . PMID   23162399.
  40. ↑ Corkeron MA (April 2003). "Magnesium infusion to treat Irukandji syndrome". The Medical Journal of Australia. 178 (8): 411. doi:10.5694/j.1326-5377.2003.tb05263.x. PMID   12697017. S2CID   28335891.
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