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Reassessment of Intravenous MgSO₄ Therapy in Preeclampsia–Eclampsia

From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Tennessee College of Medicine, Memphis, TN

Abstract

The occurrence of seizures in preeclamptic and eclamptic women is considered very unlikely during treatment with the standard dose of continuous intravenous magnesium sulfate. During a 21-month period, the authors encountered 13 patients who developed seizure activity while receiving intravenous MgSO₄. Serum magnesium (Mg) levels at the time of seizure were below the therapeutic range in 11 of the 13 patients, thus prompting a study of serum Mg levels in preeclamptic patients treated with MgSO₄. Random serum Mg samples were obtained from 120 patients treated with intravenous MgSO₄ for preeclampsia-eclampsia. The samples were collected 2 to 48 hours after the loading dose and while the patients were taking a maintenance dose of either 1, 2, or 3 g/hr. When a maintenance dose of 1 or 2 g/ hr was used, 98 and 50% of the respective serum magnesium values were below levels considered therapeutic by several authors. Therapeutic levels were achieved in all patients receiving a maintenance dose of 3 g/hr. The recommended maintenance dose of MgSO₄ of 1 g/hr was found insufficient to prevent the occurrence of eclamptic seizures in some preeclamptic patients.

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