A retrospective review of on-admission factors on attainment of therapeutic serum concentrations of magnesium sulfate in women treated for a diagnosis of preeclampsia

Leetheeragul, Jarunee; Boriboonhirunsarn, Dittakarn; Reesukumal, Kanit; Srisaimanee, Nusara; Horrasith, Siriluck; Wataganara, Tuangsit

doi:10.1080/14767058.2018.1489531

Cited by 12 publications

(19 citation statements)

References 33 publications

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“…The association between elevated BMI and sub-therapeutic MgSO 4 levels was not con rmed in our research, which was inconsistent with previous reports [16,27,28] . The reason may be related to the small sample of cases, which lead to the weakening of statistical signi cance.…”

Section: Discussioncontrasting

confidence: 99%

“…The elimination of MgSO 4 occurs primarily in the kidney, and PE associated renal damage can result in increased serum magnesium levels [16] . A previous publication showed that the glomerular ltration rate of normal pregnant women was 149 mL/min/1.73 m 2 body surface area [17] .We used Ccr to estimate the glomerular ltration rate, which was calculated by the Cockcroft-Gault equation.…”

Section: Discussionmentioning

confidence: 99%

“…However, pharmacodynamics studies showed that with IV 4 g loading and 2 g/h maintenance dose, blood magnesium concentration was twice the baseline value within 30 minutes, and plateaued at 2-4 hours with minimum uctuation [5,11,18] . At 2 hours after administration, serum magnesium ranged broadly from 1.0-3.5 mmol/L [16] . With our MgSO 4 IV infusion regimen (5 g loading dose and 1.5 g/h maintained for 10 hours, or no loading dose and 1.5 g/h maintained for 10 hours), our data suggested that for the duration of MgSO 4 maintenance dose of more than 2.375 hours, the blood magnesium concentration was more likely to reach the target range of 1.8-3.0 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients

Tang

et al. 2020

Preprint

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Background: Magnesium sulfate (MgSO4) is the standard drug for eclampsia prophylaxis and treatment. In China, the effective therapeutic serum magnesium level is 1.8–3.0 mmol/L. There is little information on how to achieve and maintain effective therapeutic concentrations. This study aimed to investigate risk factors for sub-therapeutic serum concentrations of MgSO4 in patients with severe preeclampsia. Methods: Patients with severe preeclampsia who received MgSO4 intravenous infusion were retrospectively reviewed. The maternal demographic characteristics, regimens for the administration of MgSO4, and lab test results of patients were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were conducted for the risk factors influencing the serum magnesium concentration. Results: A total of 93 patients with severe preeclampsia were included in the study. 52 (55.91%) patients did not attain therapeutic serum magnesium levels. A multivariate logistic regression analysis identified creatinine clearance (Ccr), whether the loading dose was given, and measurement time of serum magnesium concentration (referring to the time from start of MgSO4 infusion to blood draw for serum sampling) as independent risk factors for sub-therapeutic serum magnesium concentration (P < 0.05). ROC curve analysis indicated that the continuous variable Ccr had a significant predictive value for the serum magnesium concentration, which resulted in a cutoff point of 133 mL/min; while measurement time had limited predictive value, with cutoff point of 2.375 h. Conclusions: Ccr, whether the loading dose was given, and measurement time were independent risk factors for sub-therapeutic serum magnesium concentration. A loading dose of MgSO4 everytime before the maintenance dose, as well as the duration of MgSO4 maintenance dose of more than 2.375 hours are recommended for all the patients with severe PE. Routine evaluation of serum magnesium levels is a recommended practice for women with severe PE and whose Ccr is ≥ 133 mL/min.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients

Tang

et al. 2020

Preprint

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“…The elimination of MgSO 4 occurs primarily in the kidney, and PE associated renal damage can result in increased serum magnesium levels [12] . A previous publication showed that the glomerular filtration rate of normal pregnant women was 149 mL/min/1.73 m 2 body surface area [13] .We used Ccr to estimate the glomerular filtration rate, which was calculated by the Our study further found that when maternal Ccr ≥ 132.82 mL/min, the blood magnesium concentration of severe preeclampisa patients was less likely to reach the target range.…”

Section: Discussionmentioning

confidence: 99%

“…However, a pharmacodynamics study showed that with IV 4 g loading and 2 g/h maintenance dose, blood magnesium concentration was twice the baseline value within 30 minutes, and plateaued at 2-4 hours with minimum fluctuation [8,14,15] . At 2 hours after administration, serum magnesium ranged broadly from 1.0-3.5 mmol/L [12] . With our MgSO 4 IV infusion regimen (5 g loading dose and 1.5 g/h maintained for 10 hours, or no loading dose and 1.5 g/h maintained for 10 hours), our data suggested that for the duration of MgSO 4 maintenance dose of more than 2.375 hours, the blood magnesium concentration was more likely to reach the target range of…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients

Tang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Magnesium sulfate (MgSO4) is the ideal drug for eclampsia prophylaxis and treatment. In China, the effective therapeutic serum magnesium level is 1.8–3.0 mmol/L. Although there have been individual reports on the use of MgSO4 in pregnant women with severe preeclampsia, there is little information on how to achieve and maintain effective therapeutic concentrations in China. This study aimed to investigate risk factors for sub-therapeutic serum concentrations of MgSO4 in patients with severe preeclampsia.Methods: Patients with severe preeclampsia who received MgSO4 intravenous (IV) infusion were retrospectively reviewed. The maternal demographic characteristics, regimens for the administration of MgSO4, and lab test results of patients were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were conducted for the risk factors influencing the serum magnesium concentration.Results: A total of 93 patients with severe preeclampsia were included in the study. There were 41 (44.09%) patients attained therapeutic serum magnesium levels and 52 (55.91%) patients did not. A multivariate logistic regression analysis identified creatinine clearance (Ccr), whether the loading dose was given, and measurement time of serum magnesium concentration (referring to the time interval from measurement of blood magnesium concentration to the beginning of maintenance dose administration) as independent risk factors for sub-therapeutic serum magnesium concentration (P < 0.05). ROC curve analysis indicated that the continuous variable Ccr had a significant predictive value for the serum magnesium concentration, which resulted in the area under ROC curve of 0.715 and a cutoff point of 132.82 mL/min, while measurement time had limited predictive value, with the area under ROC curve of 0.650 and cutoff point of 2.375 h.Conclusions: Ccr, whether the loading dose was given, and measurement time were independent risk factors for sub-therapeutic serum magnesium concentration. A loading dose of MgSO4 everytime before the maintenance dose, as well as an infusion time of more than 2.375 hours for MgSO4 maintenance dose are recommended for all the patients with severe PE. Routine evaluation of serum magnesium levels is a recommended practice for women with severe PE and whose Ccr is ≥ 132.82 mL/min.

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Clinical Experiences of Intravenous Hydralazine and Labetalol for Acute Treatment of Severe Hypertension in Pregnant Thai Women

Chera-aree

Tengtrakulcharoen

Leetheeragul

et al. 2020

The Journal of Clinical Pharma

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Response to acute treatment of severe hypertension during pregnancy in Asian women was not known. Labor and delivery checklists of Thai women treated with intravenous hydralazine or labetalol for systolic blood pressure (SBP) ≥ 160 or diastolic blood pressure (DBP) ≥ 110 mm Hg from January 2011 to December 2013 were reviewed as parts of an audit. Primary outcome was prompt achievement of SBP 140-150 and DBP 90-100 mm Hg after the first bolus. Secondary outcomes were medication-related undesired effects. The mean ± standard deviation age and prevalence of chronic hypertension in hydralazine (n = 62) versus labetalol (n = 64) groups were 32.5 ± 6 versus 29.9 ± 6.8 years and 50% versus 21.9%, respectively (P < .05). Magnesium sulfate was promptly administered on admission to every woman to prevent seizure. Targeted blood pressure was timely achieved in 41.9% and 67.2% of the hydralazine and labetalol groups, respectively (P < .05). Nonreassuring fetal heart rate occurred in 51.6% and 32.8% of the hydralazine and labetalol groups, respectively (P = .05). The prevalence of cesarean section and Apgar score < 7 were not significantly different (P > .05). Real-life clinical experiences suggested significant advantages of intravenous labetalol over hydralazine in pregnant women with severe hypertension.

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A retrospective review of on-admission factors on attainment of therapeutic serum concentrations of magnesium sulfate in women treated for a diagnosis of preeclampsia

Abstract: On-admission factors, especially BMI and renal clearance indices, of women with PE may affect timely attainment of therapeutic serum magnesium levels. Validation of its clinical impact requires further study focusing on women with severe PE.

Cited by 12 publications

References 33 publications

Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients

Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients

Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients

Clinical Experiences of Intravenous Hydralazine and Labetalol for Acute Treatment of Severe Hypertension in Pregnant Thai Women

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