Acute management of torsades de pointes

TdP: torsades de pointes; IV: intravenous; ACLS: Advanced Cardiac Life Support; ECG: electrocardiogram.

* Refer to UpToDate content on ACLS in adults.

¶ Optimal timing of magnesium administration relative to cardioversion has not been determined. The rate of magnesium infusion is slower when the patient has a pulse, as rapid magnesium infusion can cause hypotension and asystole.

Δ Tests include basic metabolic panel (eg, serum electrolytes, potassium, and magnesium) with liver and kidney function tests. If illicit drug or medication misuse is suspected, toxicology testing can be obtained.

◊ Reduce the rate and watch for any recurrent TdP. Discontinue the pacing wire if there is no recurrent TdP (usually within 1 to 2 days). Refer to UpToDate content for further information.

§ The initial dose of isoproterenol in adults is 2 mcg/min and in children is 0.05 to 0.1 mcg/kg/min (maximum initial dose is 2 mcg/min); the dose is then titrated to achieve a heart rate of 100 beats per minute.