Eclampsia & Pre-Eclampsia
Magnesium sulfate is the drug of choice for the eclampsia in the obstetrics patients, it is a life saving drug which should be available in all the health care centers along with the antidote Calcium Gluconate for the the management of Magnesium Sulfate toxicity.
Magnesium Sulfate Schedule for severe Eclampsia and Pre-eclampsia
Magnesium sulfate is available in 20% solution.
Give 4 mg IV over 5 minute
Give 8 mg IM (4 mg in each buttock)
- Make sue the IM injection is given under aseptic condition, warn the patient that she will feel the warmth while injecting magnesium sulfate IM.
- If the convulsion reoccurs after the 15 minute of injection, give 2 mg magnesium sulfate (50% solution) intravenously (IV) over 5 minute.
Magnesium Sulfate 50% Solution + 1 mL of 2% Xylocaine(Local Anesthetics)
Give 4 mg IM every 4 hours in alternate buttocks.
- Treatment should be continued for 24 hours after delivery or the last time of convulsion.
- Conditions before giving the repeated dose of Magnesium Sulfate are.
- Urine output should be at least 30 ml per hour over the last 4 hours .
- Respiratory Rate (RR) should be at least 16 per minute.
- Make sure patellar reflexes are present.
Note:In case if the above mentioned conditions are not present ,withhold the drug.
In case of Respiratory Arrest:
Protect the Airway and assist the ventilation with bag and mask , Endotracheal Intubation may be needed of the condition is severe so make sure all the anesthetic emergency airway management apparatus are ready before injecting magnesium sulfate.
Calcium Gluconate is the antidote for Magnesium Sulfate toxicity.
Inject Calcium Gluconate(10%) Solution , (10 ml), Give 1 gm IV slowly until the drug antagonizes the effects of Respiratory Arrest and Respiration begins.
The full dose of magnesium sulfate regimens (IV and IM) are recommended for the treatment of eclampsia, in case if it is not possible to administer the full magnesium sulfate regimens in some hospital settings, give only magnesium sulfate loading dose and transfer the patient to the higher center immediately for the further management of Eclampsia.
IN CASE IF THE MAGNESIUM SULPHATE IS NOT AVAILABLE DURING ECLAMPSIA
Use Diazepam in case if Magnesium Sulfate is not available
Diazepam Schedule for Severe Eclampsia and Pre-eclampsia
Inject Diazepam 10mg Intravenously (IV) slowly over 2 min, and if the convulsion reoccurs repeat the loading dose of Diazepam.
Four Ampules of Diazepam (Each ampule contains 10 mg ), total 40 mg diazepam should be titrated in a 500 ml solution of Normal saline or Ringer lactate solution should be continued to keep the patient sedated and arousable, make sure not to give more than maximum 100 mg of diazepam in 24 hours.