Case: 19/M/F, G1P0 at 32W of pregnancy diagnosed with pre eclampsia at 28W of gestation.
Question
a) Signs and symptoms of impending eclampsia
b) Magnesium sulphate
Signs and symptoms of impending eclampsia
1) Headache
2) N & V
3) Visual Disturbances
4) Right upper quadrant pain
5) Progressively oedema (non dependant)
6) Frothy urine (proteinuria
Magnesium sulphate
Magnesium sulfate is superior to other AED (phenytoin, diazepam).
Indications:
1) Eclampsia
2) Fulminating severe PE either:
a) Severe hypertension (MAP: >125 mmHg, SBP: >170 mmHg, DBP: >110 mmHg); OR
b) Hypertension with proteinuria (BP: >180/90 mmHg, proteinuria: >0.3g/24h), AND one of the following:
i. Clonus (>3 beats)
ii. Severe persistent headache
iii. Visual disturbance
iv. Epigastric pain
v. Platelet count <100>
Protocol for use of Magnesium Sulfate:
(5ml vial contain 2.5g MgSO4 ~0.5g/ml)
Loading Dose – 4g Magnesium Sulfate
8ml (4g) + 12ml 0.9% saline IV over minimum of 10 - 15 minutes
Maintenance Dose
1g/h for at least 24h after last seizure or delivery
Add 4 vials (10g) to 30cc of normal saline & run at 5cc/h
If further fits occur give a further slow IV dose of 2g & continue the maintenance infusion
Contraindications for Magnesium Sulfate:
Cardiac failure
Acute renal failure
Drug monitoring:
Clinical
1) Patellar reflex:
- after completion of loading dose
- half hourly whilst on maintenance infusion
- use elbow reflex if epidural in situ
2)Respiratory rate : should be >16/min
3)Hourly urine output : should be >25ml/h (urine output is critical as serum Mg level depends on renal excretion)
4) Pulse Oximetry : must remain >90%
Serum Mg level should be checked when:
Oliguria (<25ml/h)
Respiratory rate <16/min
Pulse oximetry <90%
Continuing fit
Toxicity (therapeutic range: 2-4 mmol/l @ 4-8 mg/dl)
Weakness
Nausea
Feeling of warmth 5mmol/l
Flushing
Double vision
Muscle paralysis 6-7 mmo/l
Respiratory arrest
Cardiac arrest >12 mmol/l
[Labor suite Management by Dr Adibah Ibrahim]
this case similar to my case that i clerked today....=)
ReplyDeletemaybe u can enlighten us more on magnesium sulphate..how is it actually work..
ReplyDeleteHye Dr.,
ReplyDeleteI really like ur blog cause I love to read the real case. Just a short intro, im 3rd year med student. just want to ask is impending eclampsia same as pre-eclampsia.
Dear Evie Evelyn.
ReplyDeleteThanks for dropping by. to fully understand this topic, it's good for you to read the whole chapter about hypertensive disorder in pregnancy. One of hypertensive disprder in pregnancy is Pre eclampsia- eclampsia.
Pre eclampsia is simply means gest HPT+ significant proteinuria.
Pre eclampsia can futher be classified as mild, moderate and severe or impending eclampsia.
There are pathophysiology why sign and symptoms of impending eclampsia.. Headache, N&V as well as visual disturbance are due to cerebral edema that finally lead to icrease ICP.. right upper quadrant pain are d/t stretching of the liver capsule. Progressive edema previously a characteristic of pre eclampsia but for current definition, it does not necessarily present. but as a medical student, consider it as a YES.. meanwhile, frothy urine is due to proteinuria....
in other words, impending eclampsia is a WARNING SIGN that the patient may have eclampsia a.k.a seizure
I am IE mother...Delivered preterm baby girl at 34w, weight 1.485kg on 27 Jan 2014@Hosp.Putrajaya...
Delete31/M/F, G1P0,
Final Diagnosis:
Post emergency upper tranverse segment c-section at 34w for IE with IUGR.
at 6-7 mEq/l cause muscle paralysis or absence of deep tendon reflex?
ReplyDeletedr, dilution for maintenance dose is mistaken. 10mg added to 30cc n not 50cc. typo kot.
ReplyDeletethank you anon.. you are right... diluting 30CC + 20cc (10mg) will give to 50cc=10 mg... so 5 cc=1g... thank you very much..very appreciated it
ReplyDeletejust encounter a case presented by HO but specialist claimed not impending eclampsia.. pt had epigastric pain, headache post lscs, otherwise vital signs all normal and normal urine
ReplyDeletesounds like post spinal headache and dyspepsia to me as well.. to say it is impending eclampsia, first you must have the high BP and second thing is significant proteinuria
ReplyDeleteDoc,can u have a normal bp with significant proteinuria and stil say it pre eclampsia though patient is on high doses of anti hypertensive?
ReplyDeleteLook at the BP during initial presentation. if it high with significant proteinuria and the bp already controlled by anti hpt, then it is..
ReplyDeletebut if initial bp is not high and only protein is high, then look at the PE profile esp Uric acid, platelet and liver function test to aid u in making diagnosis
That means both mild or severe PE has the chance to develop impending eclampsia?
ReplyDeleteDoc, have encountered a case where the patient has generalized oedema in late preg with normal bps u/a not done and the client has no complain at all. Could you say its pet
ReplyDeleteDear med students and junior docs, always use abbreviation PET for pre-eclampsia - so not to confuse with PE for pulmonary embolism.
ReplyDeletePET = pre eclamptic toxemia
Thanx jacknaim..sangat membantu kami yg belajar midwife...😄
ReplyDeleteThanx jacknaim..sangat membantu kami yg belajar midwife...😄
ReplyDeleteThanx jacknaim..sangat membantu kami yg belajar midwife...😄
ReplyDelete