Monday, April 11, 2016

Magnesium Sulphate in pregnancy

INDICATION
Prevention of eclamptic fit
Abort eclamptic fit
Fetal neuroprotection following preterm birth
ADMINISTRATION
IV: 4g slow bolus over 10 minutes as loading dose, followed by 1-2 g/hour Sulphate maintenance infusion given via a controlled infusion pump.

IM: 4g IV slow bolus over 10 minutes, followed immediately by 10g IM, then 5 g IM every 4 hours in alternate buttock.

RECURRENT SEIZURE:
2 - 4g of MgSO4 is given over 5-10 minutes.

MAXIMUM INFUSION RATE
4g/hr

To be infused <150mg/min
MONITORING
Looking for signs of toxicity (especially loss of deep tendon reflexes, respiratory depression with rate <16/minute) and renal impairment (hourly urine output <30 ml/hour).

ANTIDOTE
Calcium Gluconate 1g in 10 mL (2.2mmol Calcium in 10mL) over 3 to 10min

When MgS04 is administered it should be continued for 24 hours following birth, or for 24 hours after the last seizure

Before discontinuation of MgSO4 therapy:
  • the blood pressure should be stable (consistently below 150/100)
  • the patient should have adequate diuresis
  • the patient should be clinically improved (absence of headache, epigastric pain).


REFERENCES
1. Malaysian CPG Management of Hypertension 4th edition
2. King Edward Memorial Hospital Guideline, Jan 2015
3. Queen Elizabeth Dilution Protocol Guideline


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