Which medication is used to treat torsades de pointes in unstable pediatric tachycardia?

Which medication is used to treat torsades de pointes in unstable pediatric tachycardia?

• A. Magnesium Sulfate 25 mg/kg IV/IO in 50 mL NS over 10 minutes
• B. Adenosine
• C. Amiodarone
• D. Epinephrine

Answer: (A)

Torsades de pointes is a ventricular tachycardia linked to prolonged QT, and magnesium sulfate is the drug of choice to treat it in children. Magnesium helps stabilize the cardiac membrane and suppress early afterdepolarizations that drive this rhythm, often working even if magnesium levels aren’t low. The recommended pediatric dose is 25 mg/kg IV/IO, diluted in 50 mL normal saline and given over about 10 minutes, up to a maximum of 2 g. This treatment should be given promptly, even as you assess the need for synchronized cardioversion if the patient is unstable, because addressing the QT-related mechanism can terminate or prevent progression of the arrhythmia. Other drugs like adenosine won’t resolve torsades, and while amiodarone has a role in other VT/VF scenarios, magnesium is specifically indicated for torsades, and epinephrine is not the first-line choice for this rhythm.

Torsades de pointes is a ventricular tachycardia linked to prolonged QT, and magnesium sulfate is the drug of choice to treat it in children. Magnesium helps stabilize the cardiac membrane and suppress early afterdepolarizations that drive this rhythm, often working even if magnesium levels aren’t low. The recommended pediatric dose is 25 mg/kg IV/IO, diluted in 50 mL normal saline and given over about 10 minutes, up to a maximum of 2 g. This treatment should be given promptly, even as you assess the need for synchronized cardioversion if the patient is unstable, because addressing the QT-related mechanism can terminate or prevent progression of the arrhythmia. Other drugs like adenosine won’t resolve torsades, and while amiodarone has a role in other VT/VF scenarios, magnesium is specifically indicated for torsades, and epinephrine is not the first-line choice for this rhythm.