MAGNESIUM SULPHATE

REGIMEN
By: Nurul Ain Bt. Zainal Abidin
Mrs Aliah, a 35 year old primigravida at 32 weeks of gestation is
admitted for history of convulsion once at home. Prior to that, she
had severe headache with vomiting. She is a known case of pre-
eclampsia. On examination, her blood pressure is 170/112 mmHg
with 3+ proteinuria.
SUMMARY OF CASE
Diagnosis: Eclampsia
MECHANISM OF ACTION
The mechanism of action is multifactorial .
Eclampsia is due to cerebral vasospasm. MgSO4 acts by
opposing the calcium dependent arterial constriction, thereby
relieving vasospasm and lowering the peripheral resistance
It acts on the cerebral endothelium to limit the vasogenic
cerebral edema.
MgSO4 is also an NMDA (N-methyl-D-aspartate) receptor
antagonist.
Seizure is thought to be mediated by the stimulation of NMDA
receptor. So, MgSO4 acts centrally to inhibit NMDA receptors,
providing anticonvulsant activity by increasing the seizure
threshold.

INDICATIONS OF MAGNESIUM SULPHATE

Hypomagnesemia
Prevent seizures associated with pre eclampsia
Control of seizures with eclampsia

PRITCHARDS REGIMEN
Loading dose
4g slow IV 4-5 minutes, 10 gms IM (5 gms deepo IM in each
buttock)
Maintenance dose
5g every 4
th
hourly in alternate buttocks till 24 hours after the
fit or delivery whichever is later

ADVERSE EFFECTS
Respiratory paralysis
Hypothermia
Pulmonary edema
Depressed reflexes
Drowsiness
Hypocalcemia, hypophosphatemia
MAGNESIUM TOXICITY
Therapeutic level is 5-7 mEq/L
Toxicity can be confirmed by these symptoms
Loss of deep tendon reflex: (8-9 mEq/L)
Respiratory depression: (10-12 mEq/L), > 14 mEq/L
Monitoring of magnesium is done by checking few signs and measurement
as follows
Presence of deep tendon reflex
Urine output > 30 ml
Respiratory rare > 16 breaths/ min
Diastolic BP > 70mm hg
Treatment = 10% 10 ml calcium gluconate slow IV for 10 minutes


GUIDELINES FOR USAGE OF
MAGNESIUM SULPHATE
NICE
MgSo4 is given to women in critical setting, who has
severe hypertension or severe pre-eclampsia has or previously
had an eclamptic fit
Use the collaborative eclampsia trial; loading dose of 4 g
should be given intravenously over 5 minutes, followed by an
infusion of 1 g/hour maintained for 24 hours
World Health Organisation. Recommendations for prevention
and treatment of pre-eclampsia and eclampsia. 2011.

"Magnesium sulfate is the drug of choice for preventing and
treating convulsions in severe pre-eclampsia and eclampsia." ....
Maintenance dose: "Give 5 g of 50% magnesium sulfate solution
with 1 mL of 2% lignocaine in the same syringe by deep IM
injection into alternate buttocks every four hours. Continue
treatment for 24 hours after delivery or the last convulsion,
whichever occurs last."

Queensland Maternity and Neonatal Clinical Guideline:
Hypertensive disorders of pregnancy. 2010, amended 2013


"Magnesium sulfate is the anticonvulsant drug of choice for the
prevention and treatment of eclampsia. ...
Magnesium sulfate should be continued for 24 hours after birth

REFERENCES
Obstetric today, 2
nd
edition, hypertensive disorders in pregnancy
http://www.rcog.org.uk/womens-health/clinical-
guidance/magnesium-sulphate-eclampsia-prophylaxis-query-
bank
WHO recommendations for Prevention and treatment of pre-
eclampsia and eclampsia