What is Eclapmsia?
When Pre-Eclampsia when complicated with convulsions and/or coma is called Eclampsia. The term ‘Eclampsia’ derived from the Greek Word meaning ‘Like a flash of Lightening’ which may occur abruptly without any warning manifestations.
Why Magnesium sulphate is chosen for Eclampsia?
Compared to other Drugs. magnesium sulfate has got the following benefits:
- It controls fits effectively without any depression effect to the mother or the infant.
- Reduced risk of recurrent convulsions.
- Significantly reduced maternal death rate (3%)
- Reduced perinatal mortality rate.
How does it Act ?
It acts as a membrane stabilizer and neuroprotector. It reduces motor endplate sensitivity to acetylcholine. Magnesium blocks neuronal calcium influx also. It induces cerebral vasodilatation, dilates uterine arteries, increases production of endothelial prostacyclin and inhibits platelet activation. It has no detrimental effects on the neonate within therapeutic level.
What are the Regimens?
|Regimen||Loading Dose||Maintenance Dose|
|Pritchard Regimen||4gm IV over 3 to 5 Minutes followed by 10gm Deep IM (5gm in each Buttock)||5gm 4th Hourly in alternate Buttocks|
|Sibai Regimen||6gm Slow IV over 20 mins||2gm per Hour IV infusion|
|Zuspan Regimen||4gm Slow IV over 5 to 10 mins||2gm per Hour IV infusion|
Repeat injections are given only if the knee jerks are present, urine output exceeds 30 mL/hour and the respiration rate is more than 12 per minute. Magnesium sulfate is continued for 24 hours after the last seizure or delivery whichever is /later. For recurrence of fits, further 2 gm IV bolus is given over 5 min in the above regimen
What is the Therapeutic Level?
The therapeutic serum level of Magnesium sulphate is 4-7 mEq/L.
What are the Side Effects?
- Signs of an allergic reaction (rash; hives; itching; breathing difficulties; chest tightness; or swelling of the mouth, face, lips, or tongue)
- Dizziness, flushing, or faintness
- Irregular heartbeat
- Muscle paralysis or muscle weakness
- Severe drowsiness
What is the Antidote?
The Antidote for Magnesium Sulphate is Calcium Gluconate.
Nurses Role in Magnesium Sulphate therapy
- Explain the Procedure to the mother and give reassurance.
- Monitor vitals signs and Spo2 through out the procedure.
- monitor serum magnesium levels.
- Specifically monitor the patients for magnesium toxicity. ( decreased patellar reflex, despiratory depression, reduced urine output, confusion).
- catheterize the mother & Monitor urine output hourly to know the function of the kidney (>30ml/hour).