There has been increasing interest in the use of intravenous magnesium in a number of clinical settings.

Torsade de pointes is a rare form of polymorphic ventricular tachycardia with a characteristic changing morphology of the QRS complex with the axis twisting around an imaginary baseline. It can occur in the setting of the critically ill patient for a number of reasons: concomitant administration of a number of drugs including antiarrhythmic drugs, metabolic abnormalities such as hypokalemia, hypocalcemia, and hypomagnesemia, and bradycardia. Withdrawal of offending drugs, correction of metabolic abnormalities, and pacing, together with intravenous administration of magnesium sulfate (2-3 g), form the cornerstone of therapy. Magnesium may work in the presence of normal plasma magnesium levels. It may also be of use following cardiac surgery where significant magnesium depletion can occur in the immediate postoperative period. Its role in other settings such as acute myocardial infarction remains uncertain.

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