Magnesium intoxication in women with preeclampsia with severe features treated with magnesium sulfate

Abstract

Objective: To evaluate the maternal-neonatal outcome in magnesium (Mg)-intoxicated women with preeclampsia with severe features (PESF) treated with magnesium sulfate (MgSO 4 ). Methods: A total of 19 Mg intoxicated PESF women (cases) were compared with 166 PESF women without signs of intoxication (controls). Results: Mg serum levels of cases was higher compared to control group (12.36 ± 3.54 mg/dl versus 2.69 ± 0.83 mg/dl). 3 women died and 3 had major maternal morbidity in cases group compared with zero in the control group (P = 0.009). Mg intoxication was also significantly associated with perinatal deaths and low Apgar scores at 1 and 5 minutes. Conclusion: Mg intoxication is associated with a increased risk of maternal and perinatal mortality and morbidity.

Magnesium Sulfate in the Treatment of Pre-Eclampsia and Its Adverse Effects

“…Initially, it was believed that eclamptic seizures had a similar pathophysiology to other seizure disorders, however, the usual anticonvulsant drugs have not been shown to be as beneficial as MgSO4 in controlling eclamptic seizures. In this sense, studies show that magnesium sulfate proved to be a superior agent to benzodiazepines, phenytoin, lytic cocktail (chlorpromazine, promethazine and pethidine) and placebo in reducing the risk of eclampsia in women with PE (AKBAR et al, 2020;FERNANDES et al, 2019;PADDA et al, 2021;RAMOS et al, 2017). Its low cost, easy availability, relatively simple administration and monitoring procedure, and the fact that it does not cause sedation are positive points.…”

“…MgSO4 is an anticonvulsant agent that appears to act on the central nervous system (CNS), vascular endothelium, and neuromuscular junction. In this perspective, magnesium acts as an antagonist of N-methyl-D-aspartate (NMDA) receptors, thus promoting blockade of these receptors and, consequently, generalized CNS depression and inhibition of excitability in the cerebral cortex (AKBAR et al, 2020;COUTINHO et al, 2019;DHARIWAL et al, 2017;PADDA et al, 2021). Furthermore, it is suggested that it is a potent vasodilator by decreasing intracellular calcium and stimulating the synthesis of nitric oxide in endothelial cells, causing arterial vasodilation and reduction of vasospasm.…”

“…In this context, magnesium sulfate (MgSO4) is recommended by all major guidelines as the first choice agent for the prevention and treatment of eclamptic seizures in women with pre-eclampsia and eclampsia and is used worldwide (AKBAR et al, 2020;COUTINHO et al, 2021;PADDA et al, 2021). Despite the risk of toxicity and possible adverse effects, many studies prove that MgSO4 is superior in the treatment of eclampsia compared to other drugs.…”

Magnesium sulfate poisoning treated with hemodialysis: a case report

“…In addition, some of the cases had dementia or cerebrovascular events and couldn't express their symptoms, and the magnesium serum concentration was not examined. All of the cases were treated with fluid infusion (normal saline) and diuretics except one case that was managed by continuous hemodiafiltration (CHDF) and after 4 days died at the hospital [18][19][20][21][22][23].…”

Intoxicación con Sulfato de Magnesio en Preeclampsia y Eclampsia

“…En cuanto a las complicaciones maternas sobre la intoxicación con MgSO4 tenemos los siguiente hallazgos: Akbar et al, en el 2020 en su estudio retrospectivo, analizo 185 gestantes, encontró muerte materna en el 15%, edema pulmonar en el 25,5% y falla renal en el 7% de las pacientes, con un valor de p <0,01 lo que significa es estadisticamente significativo (53). Pollock et al, en el 2020 en su estudio retrospectivo, analizo 170 gestantes, encontró edema pulmonar en el 5,5%, falla renal en el 4,7% y hemorragia posparto en el 1,6% de las pacientes, con un valor de p <0,01 lo que significa es estadisticamente significativo (54).…”