A low dose ('Dhaka') magnesium sulphate regime for eclampsia: Clinical findings and serum magnesium levels

Background: Eclampsia is defined as the onset of convulsions or coma during pregnancy or in post-partum period in a patient who has signs and symptoms of pre-eclampsia. It is life threatening emergency that continues to be a major cause of serious maternal morbidity and mortality also along with high perinatal mortality and morbidity. The present study undertaken to determine the efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling eclamptic convulsion and prevention of recurrence of convulsion.Methods: Out of total 60 patients enrolled in the study; 30 were given low dose magnesium sulphate regime and remaining 30 with Pritchard’s regime. Selection of patients was done with simple random sampling. Relevant history was obtained from the patient, if conscious, or from the relatives. Through clinical examination was done and blood samples were collected for investigations after securing IV line.Results: There was insignificant difference regarding type of eclampsia in both groups. Recurrence of convulsion in Pritchard’s regime group was 6.67% and in Low dose regime group found to be 10% but this was statistically insignificant. Total dose of magnesium sulphate required in Low dose regime group was less than that required for Pritchard’s regime.Conclusions: Low dose magnesium sulphate Regime proved equally effective as that of Pritchard’s regime in control of convulsion in spite of less amount of drug and comparatively low serum magnesium levels and hence there is hardly any fear of intoxicator.

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Role of low dose Magnesium sulphate in eclampsia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190313 ◽

2019 ◽

Vol 8 (2) ◽

pp. 729

Author(s):

Kajal Sinha ◽

Shail K. Sinha

Keyword(s):

Magnesium Sulphate ◽

Low Dose ◽

Serum Magnesium ◽

Tertiary Care ◽

Secondary Outcome ◽

Care Hospital ◽

Dose Regime ◽

Low Body Mass Index ◽

Developing Area ◽

A Prospective Study

Background: Eclampsia is one of the challenging medical complications seen during pregnancy. With the use of magnesium sulphate for control of convulsion in eclampsia, it can be managed effectively.Methods: This is a prospective study done in a tertiary care hospital. Considering low body mass index of patients of developing area, authors had used low dose regime of magnesium sulphate. 100 patients had been enrolled for low dose magnesium sulphate regime after categorizing patients as per inclusion and exclusion criteria. The primary outcome to be measured was recurrence of fits in any patients who received low dose magnesium sulphate. The secondary outcome measured were development of any toxicity, level of serum magnesium level, maternal and perinatal outcome.Results: It was observed that 93% of the patients responded to low dose regime. 7% developed recurrence of fits for that additional dose of 2 gram of 20% magnesium sulphate was given to the patients. Not even a single patient developed signs of toxicity. 94% and 95% of the patients acquired therapeutic level of serum magnesium at 4 hours and 10 hours of magnesium sulphate administration, respectively. Maternal mortality was 5% and perinatal mortality was 24.4%.Conclusions: Low dose of magnesium sulphate can prevent and treat eclampsia. Low dose regimen also reduces incidence of toxicity with improved maternal and perinatal outcome.

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Efficiency and safety of single dose Magnesium sulphate in eclamptic convulsion

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172934 ◽

2017 ◽

Vol 6 (7) ◽

pp. 3058

Author(s):

Vinaya Goudar ◽

Rashmi Naganagoudaru

Keyword(s):

Single Dose ◽

Magnesium Sulphate ◽

Urban Areas ◽

Low Dose ◽

Post Partum ◽

Efficacy And Safety ◽

Medical Sciences ◽

Life Threatening ◽

Clonic Seizures ◽

Life Threatening Complication

Background: An acute and life-threatening complication of pregnancy is characterized by the appearance of tonic clonic seizures, in a patient with pre-eclampsia. Objective of the study was to study the efficacy and safety of a ‘single dose’ of magnesium sulphate in treatment of eclamptic convulsions.Methods: The present prospective study was undertaken among women aged between 18-35 years outpatient’s Department of gynecology in Karnataka Institute of Medical Sciences (KIMS) Hubli, Karnataka, India. The study was undertaken during December 2009 to November 2010.Results: The incidence of eclampsia in our study was 2.12%. Eclapmsia is more common in patients from rural (89%) as compared to urban areas (11%) in our study. In our study eclampsia is more common in unbooked cases (80%). Majority of patients (72%) in our study group were illiterates. 61%, 28% of patients had antepartum and intrapartum eclampsia respectively in our study. We had only 11 post-partum convulsions Table 2. 80% of patients in our study were more than 28 weeks of gestations. 65% of the patients had <5 episodes of convulsions. The number of convulsions did not affect the recurrence, and 35% had >5 episodes. In present study 5 Patients had Systolic Blood Pressure less than 140 mmHg. Majority (52) had more than 160 mmHg 42 had in between 140 and 160 mmHg. Diastolic arterial pressure was >110 in 81% of cases. The convulsions were controlled in 75% of women. Recurrence of convulsions occurred in 25% of women after receiving the single dose magnesium sulphate regime. In our study 75% of cases, there was no recurrence of convulsions and in 25% of cases, there was recurrence of convulsions, out of which 20 cases received low dose magnesium sulphate regime and the other 5 cases received Phenytoin regime as 2nd line of treatment.Conclusions: Hence the single dose Magnesium sulphate is safe and effective in controlling convulsions.

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Magnesium Sulphate For Tetanus, review of two cases

Medicinus ◽

10.19166/med.v7i4.2386 ◽

2020 ◽

Vol 7 (4) ◽

pp. 112

Author(s):

Tirta Darmawan Susanto

Keyword(s):

Intensive Care ◽

Autonomic Dysfunction ◽

Magnesium Sulphate ◽

Case Series ◽

Clinical Findings ◽

Muscle Spasm ◽

World Health ◽

Control Muscle ◽

Hospitalization Period ◽

Health Organization

<div class="WordSection1">Introduction: Tetanus is critically ill disease with long term hospitalization period. It need to be carefully monitored, usually in intensive care unit and involves critical care physicians. Benzodiazepine is preferred by World Health Organization (WHO) for muscle spasm control in tetanus, but it will be less costly if magnesium sulphate can be used alone to control spasm and autonomic dysfunction in tetanus. We report a series of 2 tetanus cases that were treated using magnesium sulphate to provide a brief clinical description about the use of magnesium sulphate in tetanus. We also give a brief review on epidemiology, pathophysiology, clinical findings, diagnosis, and treatment of tetanus to provide implications for intensive care physicians. Methods : Case series reportResults : Two patients with tetanus was given magnesium sulphate infusion to control muscle spasm and autonomic dysfunction with good results as expected. Both of them were survive and discharged home in healthy condition.Conclusions :Magnesium sulphate can also be used to control muscle spasm and autonomic dysfunction although WHO recommend benzodiazepines for controlling muscle spasm. Intensive care physicians should have enough knowledge about tetanus and how it should be managed adequately to ensure survival from tetanus.</div>

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Posteclampsia Sudden Cardiac Arrest (SCA): A Rare Etiology

Case Reports in Obstetrics and Gynecology ◽

10.1155/2020/8862839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Nissar Shaikh ◽

Shoaib Nawaz ◽

Arshad Chanda ◽

Seema Nahid ◽

Muhmmad Zubair ◽

...

Keyword(s):

Cardiac Arrest ◽

Magnesium Sulphate ◽

Serum Magnesium ◽

Sudden Cardiac Arrest ◽

Kidney Injury ◽

Spontaneous Circulation ◽

Cardiac Biomarkers ◽

Morbidly Obese ◽

Neurogenic Pulmonary Edema ◽

Normal Range

Eclampsia is associated with high maternal and fetal morbidity and mortality. The mortality in eclampsia is reported to be secondary to cerebrovascular accidents, neurogenic pulmonary edema, or acute kidney injury leading to cardiac arrest. A rarely reported etiology is sudden cardiac arrest (SCA) immediately after the seizure activity. We report a case of morbidly obese multigravida, complicated into postnatal eclampsia developing postseizure SCA due to apnea. Case. A 35-year-old woman in 38 weeks of gestation presented to the women’s hospital emergency with hypertension and proteinuria and had lower section caesarean section under epidural anesthesia and required labetalol infusion. She developed convulsions in the 1st postoperative day, and she was started on magnesium sulphate therapy. After a few minutes, the patient had a 2nd episode of convulsions, apnea, cyanosis, and cardiac asystole requiring cardiopulmonary resuscitation and spontaneous circulation returned in 3 minutes. Her endotracheal intubation was difficult, but we succeeded in the 2nd attempt. She was sedated, ventilated, and required noradrenaline to maintain hemodynamics. Her ECG, echocardiogram, cardiac biomarkers, CT chest/brain, and serum magnesium levels were within normal range. The patient was weaned from vasopressor and ventilator by day 2 and extubated. She became awake; labetalol and magnesium sulphate infusions were stopped by day 3. The patient was transferred to the ward on day 5; from there she was discharged home on day 8 on oral labetalol. She was followed up in an outpatient clinic after 4 weeks and remained comfortable, and blood pressure was controlled with tablet labetalol and repeat echocardiogram was normal. Conclusion. Eclampsia patients can have apnea after seizures, progressing to SCA.

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A comparative study of low dose magnesium sulphate therapy with Pritchard’s regime in management of Eclampsia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194352 ◽

2019 ◽

Vol 8 (10) ◽

pp. 3907

Author(s):

Vijay M. Kansara ◽

Payal Sureshkumar Patel ◽

Ajesh N. Desai

Keyword(s):

Perinatal Mortality ◽

Magnesium Sulphate ◽

Low Dose ◽

Fetal Outcome ◽

Control Group ◽

Average Weight ◽

Indian Women ◽

Mortality And Morbidity ◽

Labour Room ◽

And Control

Background: Eclampsia is one of the most common causes of maternal and perinatal mortality and morbidity in India. Amongst the principles of management of eclampsia, the first is the control of convulsions. Magnesium sulphate is the main stay of treatment in eclampsia and imminent eclampsia. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used. The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with standard Pritchard regimen in control of eclampsia.Methods: The study was carried out at emergency labour room, GMERS Sola Civil Hospital Ahmedabad. 120 patients of eclampsia were divided randomly into study group (n=60) receiving low dose MgSO4 and control group (n=60) receiving Pritchard regimen. The recurrence of convulsion, toxicity of MgSO4 and maternal and fetal outcome was studied.Results: It was observed that with low dose MgSO4 regime, convulsions were controlled in 91.7% of the cases. With standard Pritchard’s regime convulsions were controlled in 95% of patients. The maternal and perinatal mortality and morbidity were comparable in both groups.Conclusions: Low dose magnesium sulphate therapy is as effective as Pritchard’s regime for controlling convulsions in eclampsia and can be safely given in Indian women.

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