Management of eclampsia: cardiopulmonary arrest resulting from magnesium sulfate overdose

Swartjes, J.M.; Schutte, M. F.; Bleker, O. P.

doi:10.1016/0028-2243(92)90217-m

Cited by 31 publications

(11 citation statements)

References 13 publications

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“…ROSC resulted within 3 min of CPR in spite of difficulties in resuscitation due to obesity [10]. Sudden cardiac arrest soon after convulsions can be due to magnesium sulphate toxicity [11,12] or direct cardiac dysfunction such as atrial fibrillation, ventricular fibrillation [13]. These were not documented in Mrs S at or immediately after cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Acute Fulminant Eclampsia with Cardiopulmonary arrest, Pulmonary Oedema and PRES: Maternal and Fetal Outcome

Dasari¹,

Nithin²

2021

ICRES

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Complicated eclampsia resulting in cardiac arrest and subsequent fetal and maternal survival is rare. A 25-year-old primigravida was referred after initial resuscitation for cardiac arrest following a maternal collapse during pregnancy due to eclampsia at 36 weeks of pregnancy. The diagnosis at referral was antepartum eclampsia, pulmonary oedema and intrauterine fetal death. Re-evaluation revealed presence of fetal cardiac activity on ultrasound and an immediate emergency Caesarean Section was carried out and a live baby with APGAR of 3/10 was delivered and cared for in neonatal intensive care unit after intubation and positive pressure ventilation. Mother was managed in obstetric intensive care unit and was on ventilator for 72 h. She was treated for pulmonary oedema and persistent hypertensive crisis requiring multiple antihypertensives including nitroglycerine. Her echocardiogram showed global hypokinesia and left ventricular ejection fraction of 45% on day 1 which later improved to normal by day 15. MRI brain showed features of posterior reversible encephalopathy syndrome. She was given levitricetam for seizure prophylaxis. In addition, she required treatment for aspiration pneumonia. She was discharged after 16 days on two antihypertensive drugs along with her baby in good health. Timely resuscitation following cardiac arrest and transport to a tertiary care centre and control of hypertensive crisis with multidisciplinary care were the life-saving factors in this case.

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Section: Discussionmentioning

confidence: 99%

Acute Fulminant Eclampsia with Cardiopulmonary arrest, Pulmonary Oedema and PRES: Maternal and Fetal Outcome

Dasari¹,

Nithin²

2021

ICRES

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“…a) CCT scan/nativ, retrospectively a pathologic lesion can be seen (arrow). (b) MRT head FLAIR, a right frontal lesion is identifiable, which was read by the radiologist as cavernoma with hemorrhage or intracerebral hemorrhage explain why albeit the problem of magnesium overdosing has been known for at least 30 years it is still reported frequently [13][14][15][16][17]. Most scientific societies recommend administering 4 to 6 g of magnesium sulfate to women with eclampsia to prevent further eclamptic fits [2,5,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Magnesium sulfate overdose resulting in maternal cardiac arrest: a case report

Wex¹,

Luze²,

Franke³

et al. 2020

Clin Obstet Gynecol Reprod Med

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A case is presented which highlights the importance of reconsideration of potential differential diagnoses when clinical improvement after therapeutic interventions is lacking. Attention is also directed to the fact that not always the most obvious or even prehospitally established diagnosis is the correct one. In our case report the circumstances pregnancy and seizure were directly linked to the diagnosis of eclampsia but this diagnosis had to be corrected in the later course. This case report highlights the importance of rethinking potential differential diagnoses. A complicating factor was an iatrogenic overdosage of magnesium due to imprecise and confusing drug labeling (g, mg, mmol, mval) which resulted in a cardiac arrest. Furthermore, the neuroprotective effect of magnesium and the positive impact on the outcome in children, as well as the possible cardioprotective effect of magnesium in mothers is demonstrated.

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“…Cases of acute magnesium toxicity resulting in respiratory impairment,1 cardiopulmonary arrest2 3 and neurological depression,4 have been published. Magnesium levels of 8.13 and 8.6 mmol/L4 were observed.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic magnesium toxicity following intravenous infusion of magnesium sulfate: risks and strategies for prevention

Cavell¹,

Bryant

Jheeta

2015

BMJ Case Reports

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SUMMARYA 65-year-old man being treated with radiotherapy and chemotherapy for recurrent colonic adenocarcinoma was admitted for management of hypokalaemia and hypomagnesaemia secondary to diarrhoea. He was treated with intravenous infusions of potassium chloride and magnesium sulfate. Following an infusion of magnesium sulfate, he experienced a sudden neurological deterioration. A CT of the head revealed no haemorrhage or evidence of acute ischaemic injury. Results of serum biochemistry later that day revealed an elevated magnesium level. Iatrogenic magnesium toxicity was suspected. Further discussions between the pharmacist and ward staff confirmed that a medication error had been made in the preparation of the infusion resulting in an overdose of intravenous magnesium. BACKGROUND

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Management of eclampsia: cardiopulmonary arrest resulting from magnesium sulfate overdose

Cited by 31 publications

References 13 publications

Acute Fulminant Eclampsia with Cardiopulmonary arrest, Pulmonary Oedema and PRES: Maternal and Fetal Outcome

Acute Fulminant Eclampsia with Cardiopulmonary arrest, Pulmonary Oedema and PRES: Maternal and Fetal Outcome

Magnesium sulfate overdose resulting in maternal cardiac arrest: a case report

Iatrogenic magnesium toxicity following intravenous infusion of magnesium sulfate: risks and strategies for prevention

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