Magnesium toxicity is entirely predictable because it follows the serum level in a fixed order, and that order is the assessment schedule. Run the hourly safety check on a real patient and watch the ladder climb — reflexes go first, breathing second — and find out what happens if you reach for the antidote before you stop the infusion. Then classify a hypertensive disorder against the severe-feature criteria, and sequence the response to an eclamptic seizure.
Choose your bench
Antepartum room 4 · 33 weeks · 82 kg
Pre-eclampsia with severe features
Loading dose 4 g intravenously over 20 minutes, now on a maintenance infusion of 2 g per hour on a dedicated pump with a second-nurse independent double check. Calcium gluconate and a bag-valve mask are at the bedside. You are doing the hourly assessment.
Act in whatever order you believe is right. The patient will respond honestly.
Hold parameters, all four checked before every hourly assessment: respiratory rate at least 12 per minute, deep tendon reflexes present (at least 1+), urine output at least 30 mL/h or 100 mL over 4 hours, and level of consciousness intact.
Blood pressure and timing
Severe features present
Haemolysis screen
Proteinuria is no longer required for the diagnosis of pre-eclampsia. Waiting for it delays treatment.
Room 4 · the same patient · 33 weeks
Generalised tonic-clonic seizure
You are in the room. The patient stiffens mid-sentence and begins to convulse. She is lying supine with the head of the bed at 30 degrees. Intravenous access is in place. The magnesium infusion has not yet been started.
Click the actions in the order you would do them. Three of these buttons are things you must never do.
Steps placed correctly0 / 6
The hourly checkReflexes, respirations, urine output, consciousness