Dose of Magnesium Sulfate in the treatment of Severe Eclampsia?

1.

Elsevier ClinicalKey Clinical Overview

Treatment Rescue course could be provided as early as 7 days from the prior dose if indicated by clinical situation. Dexamethasone For HELLP syndrome: Dexamethasone Solution for injection; Adults: 10 mg IV every 12 hours for 48 hours has been reported. For preeclampsia: Antenatally, to promote fetal pulmonary maturity when delivery is anticipated within the next 7 days and gestational age is less than 34 weeks Acceptable alternative to betamethasone for fetal lung maturation Anticonvulsant (for both treatment and prophylaxis) Magnesium sulfate Dosage schedule for severe preeclampsia is the same as for eclampsia Continue magnesium sulfate for at least 24 hours after delivery, after the last seizure, or both Has been associated with an increased risk of postpartum hemorrhage and uterine atony in observational studies; however, this has not been confirmed in randomized trials Magnesium Sulfate Solution for injection; Adults: 4 to 6 g IV loading dose, followed by 1 to 2 g/hour continuous IV infusion for at least 24 hours. A 2 g IV bolus may be administered for recurrent seizures. Alternately, 4 to 5 g IV with simultaneous 10 g IM loading dose, followed by 1 to 2 g/hour continuous IV infusion or 4 to 5 g IM every 4 hours until seizures cease. Max: 30 to 40 g/day. Low-dose aspirin prophylaxis for prevention of preeclampsia Indicated for patients at high risk and should be initiated between 12 and 28 weeks of gestation (optimally before 16 weeks) High-risk status includes any of the following: history of preeclampsia, multifetal gestation, chronic hypertension, type 1 or 2 diabetes, renal disease, or autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome)

Synopsis Hypertensive emergency Acute-onset, severe systolic (160 mm Hg or greater) and/or diastolic (110 mm Hg or greater) hypertension during pregnancy or during the postpartum period lasting more than 15 minutes is an obstetric emergency Goal of emergent therapy is to achieve a blood pressure range of 140 to 150 mm Hg systolic/90 to 100 mm Hg diastolic ( not lower, to avoid hypoperfusion of fetus To reduce risk of stroke, treat with first line agent as soon as identified Treatment Give 20 mg IV labetalol or 5 mg IV hydralazine (first line drugs) If blood pressure remains elevated after 10 or 20 minutes, double the dosage Give up to a total of 4 doses; if blood pressure remains above 160/110 mm Hg, consult specialists in maternal-fetal medicine, anesthesia, or critical care Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia and seizures in eclampsia Consider intubation for patients whose condition does not respond to therapy Eclamptic seizure Treatment Position the patient in a lateral decubitus position to minimize aspiration Give IV magnesium sulfate loading dose (4-6 g) followed by continuous infusion (1-2 g/hour)

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 1, 2024.

Indications And Dosage **For eclampsia prophylaxis † or seizure prophylaxis† in preeclampsia with severe features** Intravenous dosage (magnesium sulfate) Adults: 4 to 6 g IV loading dose, followed by 1 to 2 g/hour continuous IV infusion for at least 24 hours. Max: 30 to 40 g/24 hours. Adolescents: 4 to 6 g IV loading dose, followed by 1 to 2 g/hour continuous IV infusion for at least 24 hours. Max: 30 to 40 g/24 hours. Intramuscular dosage (magnesium sulfate) Adults: 10 g IM loading dose, followed by 5 g IM every 4 hours for at least 24 hours. Max: 30 to 40 g/24 hours. Adolescents: 10 g IM loading dose, followed by 5 g IM every 4 hours for at least 24 hours. Max: 30 to 40 g/24 hours.

Indications And Dosage **For the treatment of seizures associated with severe toxemia of pregnancy (i.e., preeclampsia, eclampsia)** Intravenous or Intramuscular dosage (magnesium sulfate) Adults: 4 to 6 g IV loading dose, followed by 1 to 2 g/hour continuous IV infusion for at least 24 hours. A 2 g IV bolus may be administered for recurrent seizures. Alternately, 4 to 5 g IV with simultaneous 10 g IM loading dose, followed by 1 to 2 g/hour continuous IV infusion or 4 to 5 g IM every 4 hours until seizures cease. Max: 30 to 40 g/24 hours. Adolescents: 4 to 6 g IV loading dose, followed by 1 to 2 g/hour continuous IV infusion for at least 24 hours. A 2 g IV bolus may be administered for recurrent seizures. Alternately, 4 to 5 g IV with simultaneous 10 g IM loading dose, followed by 1 to 2 g/hour continuous IV infusion or 4 to 5 g IM every 4 hours until seizures cease. Max: 30 to 40 g/24 hours.

3.

Food and Drug Administration (DailyMed).

Publish date: April 3, 2024.

Dosage And Administration DOSAGE AND ADMINISTRATION: Magnesium Sulfate in 5% Dextrose (magnesium sulfate heptahydrate) injection, USP is intended for intravenous use only. For the management of pre-eclampsia or eclampsia, intravenous infusions of dilute solutions of magnesium (1% to 8%) are often given in combination with intramuscular injections of 50% magnesium sulfate injection, USP. Therefore, in the clinical conditions cited below, both forms of therapy are noted, as appropriate. Continuous maternal administration of magnesium sulfate in pregnancy beyond 5 to 7 days can cause fetal abnormalities. In Pre-eclampsia or Eclampsia In severe pre-eclampsia or eclampsia, the total initial dose is 10 to 14 g of magnesium sulfate. To initiate therapy, 4 g of Magnesium Sulfate in 5% Dextrose (magnesium sulfate heptahydrate) injection, USP may be administered intravenously. The rate of IV infusion should generally not exceed 150 mg/minute, or 7.5 mL of a 2% concentration (or its equivalent) per minute, except in severe eclampsia with seizures. Simultaneously, 4 to 5 g (32.5 to 40.6 mEq) of magnesium sulfate may be administered intramuscularly into each buttock using undiluted 50% magnesium sulfate injection, USP. After the initial IV dose, some clinicians administer 1 to 2 g/hour by constant IV infusion. Subsequent intramuscular doses of 4 to 5 g of magnesium sulfate may be injected into alternate buttocks every four hours, depending on the continuing presence of the patellar reflex, adequate respiratory function, and absence of signs of magnesium toxicity.

4.

Food and Drug Administration (DailyMed).

Publish date: March 1, 2024.

Dosage And Administration DOSAGE AND ADMINISTRATION Magnesium Sulfate in Water for Injection is intended for intravenous use only. For the management of pre-eclampsia or eclampsia, intravenous infusions of dilute solutions of magnesium (1% to 8%) are often given in combination with intramuscular injections of 50% Magnesium Sulfate Injection, USP. Therefore, in the clinical conditions cited below, both forms of therapy are noted, as appropriate. Continuous maternal administration of magnesium sulfate in pregnancy beyond 5-7 days can cause fetal abnormalities. In Eclampsia In severe pre-eclampsia or eclampsia, the total initial dose is 10 to 14 g of magnesium sulfate. To initiate therapy, 4 g of Magnesium Sulfate in Water for Injection may be administered intravenously. The rate of I.V. infusion should generally not exceed 150 mg/minute, or 3.75 mL of a 4% concentration (or its equivalent) per minute, except in severe eclampsia with seizures. Simultaneously, 4 to 5 g (32.5 to 40.6 mEq) of magnesium sulfate may be administered intramuscularly into each buttock using undiluted 50% Magnesium Sulfate Injection, USP. After the initial I.V. dose, some clinicians administer 1 to 2 g/hour by constant I.V. infusion. Subsequent intramuscular doses of 4 to 5 g of magnesium sulfate may be injected into alternate buttocks every four hours, depending on the continuing presence of the patellar reflex, adequate respiratory function, and absence of signs of magnesium toxicity. Therapy should continue until paroxysms cease. A serum magnesium level of 6 mg/100 mL is considered optimal for control of seizures.

5.

Spong, Catherine Y., Nelson, David B. (2024). In Goldman-Cecil Medicine (pp. 1618). DOI: 10.1016/B978-0-323-93038-3.00221-5

The medical treatment of gestational hypertension is similar to the management of chronic hypertension. Treatment of preeclampsia aims to prevent eclampsia by using magnesium sulfate (either a 4- or 6-g intravenous load, followed by 2-g per hour infusion) to prevent seizures, immediately treating severe hypertension (160/110mm Hg or greater; seeTable 221-4), and effecting prompt delivery of the fetus. In the absence of contraindications, (e.g., myasthenia gravis;Chapter 390), a patient with convulsions late in pregnancy or early in the postpartum period should empirically be given magnesium sulfate to prevent recurrent seizures even while evaluation is underway. If seizures persist despite ongoing magnesium sulfate prophylaxis, an additional 2-g loading dose should be considered, and agents that significantly depress respiratory function should be avoided. Magnesium sulfate is cleared by the kidney, so women with compromised renal function merit close observation for toxicity, which is manifested by diminished reflexes and respiratory depression. Treatment with calcium gluconate (1 g intravenously over 2 to 5minutes) and discontinuation of the magnesium sulfate reverses respiratory depression.Delivery is the only cure for preeclampsia-eclampsia. However, emergent cesarean delivery is not recommended for an eclamptic event in the absence of clinical evidence for placental abruption. Fetal compromise often resolves with maternal supportive care in the minutes following the seizure.Women should be evaluated for possible fluid overload and pulmonary edema because the majority of women with preeclampsia develop pulmonary edema after birth. Volume expansion with agents, such as albumin, may aggravate pulmonary function, and their use is not routinely recommended.