Intoxicación Neonatal por Sulfato de Magnesio: Caso clínico

Abstract

Magnesium Neonatal Intoxication: A Case ReviewMagnesium Sulfate is currently the treatment of choice for severe preeclampsia and eclampsia. Since it crosses the placenta, magnesium can reach high levels in fetal plasma, ocassionally reaching levels higher than maternal plasma. Objective: To analyze a 35 weeks gestational age newborn, who presented hypermagnesemia due to maternal treatment with magnesium sulfate (in routine dosage) indicated for severe preeclampsia. Clinical Case: The mother was infused with MgSO4 for 17 hours until pregnancy was interrupted because of fetal monitoring. The baby weighed 2,620 grams, was depressed, hypotonic, cyanotic and without respiratory effort and only partially responded to initial resucitation with positive pressure ventilation. The infant was admitted to the Neonatal Intensive Care Unit for monitoring, support and management. High levels of plasma MgSO4 were found (4.7 mg/dl), compatible with the diagnosis of hypermagnesemia. Symptoms and signs slowly disappeared, and the child was discharged after 10 days of hospitalization. Conclusion: We present the clinical case of a newborn with a history of maternal use of magnesium sulfate, who presented hypermagnesemia characterized by neonatal depression, hypotonia, central apnea with oxygen requirement and who progressively normalized in a 10 day period. RESUMENEl Sulfato de Magnesio es actualmente el medicamento de elección para el tratamiento de la embarazada con preeclampsia severa y eclampsia. Dado que atraviesa la placenta, alcanza elevados niveles en el plasma fetal, pudiendo en ocasiones superar la concentración plasmática materna. Objetivo: Analizar la evolución de un neonato de 36 semanas de edad gestacional que cursó con cuadro de hipermagnesemia secundario a tratamiento materno con sulfato de magnesio en dosis habituales, indicado como terapia de una

Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis

“…Clinical features of neonatal hypermagnesemia, magnesium ‘toxicity’, or magnesium ‘intoxication’ at birth were the focus of 5 reports (35 neonates), in which antenatal magnesium sulphate was given for pre-eclampsia/eclampsia (with exposure durations and doses ranging from 3.5 to 46 hours and 11 to 60.4 grams prior to birth, respectively) [202,205,206,213,218], and were variably described throughout the remaining reports. These included low Apgar scores, apnoea, cyanosis, hypotonia, and/or hyporeflexia, with or without the need for active resuscitation and calcium gluconate administration.…”

Neuroprotective antenatal magnesium therapy and immediate neonatal outcomes : a case control study

“…Yapılan bir çalışma anne ve bebek serum magnezyum düzeylerinin yüksek oranda korelasyonunu göstermiştir (6). Bunun yanında daha önce yapılan çalışmalar geçici hipermagnezeminin preterm bebeklerde erken dönemde hipotansiyon, solunum depresyonu, intraventriküler kanama, beslenme intoleransı ve kalp yetmezliği riskini artırabileceğini göstermiştir (6)(7)(8)(9). Ayrıca antenatal MgSO4 tedavisine ikincil prematür bebekte semptomatik erken başlangıçlı hiperkalemi gelişimini bildiren vakalar da vardır (10) .…”