Magnesium sulphate therapy in eclampsia: the Sokoto (ultra short) regimen

Abstract

BackgroundContinuing the administration of magnesium sulphate for 24 hours after the last fit in patients with eclampsia is at best empirical. The challenge of such a regimen is enormous in low-resource countries. The objective of this study was to assess the effectiveness of an ultra-short regimen of magnesium sulphate in eclamptics.FindingsThis was a prospective, cohort study of eclamptic patients admitted between July 2007 and June 2008 that were given 4 grams magnesium sulphate intravenously and 10 grams intramuscularly (5 grams in each buttock) as the sole anticonvulsant agent. Main outcome measure was the absence of a repeat fit. Other aspects of eclampsia management were as in standard practice. One hundred and twenty one (121) patients were managed with this regimen. There were 29 ante partum, 76 intrapartum and 16 post partum cases of eclampsia. Most of the patients were primigravidae (100; 83%) with an average age of 18.7 years. There were nine cases (7.4%) of recurrent fits that occurred within four hours of the loading dose. One recurrent fit occurred in the ante partum group, seven in the intra partum and one in the post partum group. There were 12 maternal deaths giving a case fatality rate of 9.9%.ConclusionLimiting the dosage of magnesium sulphate to 14 grams loading dose (4 grams intravenous and 10 grams intramuscular) was effective in controlling fits in 92.6% of cases in the study group. A properly conducted, randomized controlled trial is needed to test our proposed regimen.

Single Loading Dose of Magnesium Sulphate in Severe Preeclampsia and Eclampsia-Is it Effective? A Randomized Prospective Study

“…Several studies investigated the role of only single loading dose of MgSO 4 in managing hypertensive disorders in pregnancy [17][18][19][20][21][22]. All of them were carried out in low resource countries like Pakistan [17,18], Bangladesh [19], Nepal [20], Nigeria [21,22] and Egypt [23].…”

“…All of them were carried out in low resource countries like Pakistan [17,18], Bangladesh [19], Nepal [20], Nigeria [21,22] and Egypt [23]. Noor et al [17] conducted a study on MgSO 4 in women with eclampsia and preeclampsia at Peshawar, Pakistan in which majority of the patients received only loading dose and 5g intramuscular dose was repeated only if the patient had convulsions [17].…”

Comparison of low dose Dhaka regimen of magnesium sulphate with standard pritchard regimen in eclampsia

“…Efficacy of Ultra short regimen (4 grams magnesium sulphate intravenously and 10 grams intramuscularly as the sole anticonvulsant agent) was used in a study conducted by Ekele BA et al and was effective in controlling fits in 92.6% of cases in the study group. 6 Another study conducted by JR Chaudhary et al showed no significant difference in recurrence of convulsion, maternal mortality, serious maternal morbidity, perinatal morbidity or mortality between the low dose i.v regimen of magnesium sulphate infusion (0.6 gm/h) and standard pritchard regimen. 4 Using low dose regimens will not only decrease the risk of maternal toxicity and fetal side effects but also decrease the cost of therapy and increase its safety for rural low resources setting where magnesium sulphate level monitoring is not readily available.…”

“…4 Using low dose regimens will not only decrease the risk of maternal toxicity and fetal side effects but also decrease the cost of therapy and increase its safety for rural low resources setting where magnesium sulphate level monitoring is not readily available. 6 A low dose magnesium sulphate may be more appropriate in cases of mild renal impairment which is usually present in these patients. A study conducted by MR begum et al had explained that the low BMI of the women in Dhaka explains the efficacy of low dose regimen in controlling fits.…”

A comparative study of low dose magnesium sulphate therapy with standard pritchard's regime in the management of eclampsia

“…15,16 Ekele et al in his study demonstrated that limiting the dosage of magnesium sulphate to 14 grams loading dose (4 grams intravenous and 10 grams intramuscular) was effective in controlling fits in 92.6% of cases. 17 With Pritchard's regime, 3 (6%) patients had absent knee jerks, but no such drug toxicity was seen with low dose magnesium sulphate therapy. This is in accordance with Dasgupta who showed that magnesium toxicity was less with low dose therapy than with standard regimen.…”