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What is Which of the following is the earliest warning sign of Magnesium Sulphate toxicity? and explain in detail?
Ans. B. Loss of DTRs. (Ref Textbook of Obstetrics D.C. Dutta 6th ed, 229)SEIZURE PROPHYLAXIS IN PIH - MAGNESIUM SULFATE# Is not a hypotensive agent# Works as a centrally acting anticonvulsant# Also blocks neuromuscular conduction# Serum levels: 6-8 mg/dL# Magnesium sulfate # Monitor urine output and DTR's- Cervical dilatation of 3 to 5 cm or more, in the presence of uterine contractions, can be taken to reliably represent the threshold for active labor.# With renal dysfunction, may require a lower doseToxicity# Respiratory rate < 12 (respiratory depression develops when levels go lOmEg/L)# DTR's not detectable (earliest warning sign of toxicity =/< 10 mEq/L)# Altered sensorium# Urine output < 25-30 cc/hour# Respiratory paralysis arrest ( 3 12 mEq/L)# Antidote: 10 ml of 10% solution of calcium gluconate IV over 3 minutes- The therapeutic level of serum magnesium is 4-7 mEq/L.- The normal level of serum (blood) magnesium is 1.5 - 2.0 mEq/L (1-2 mg/dl).Hypertension in pregnancy CommentsRxGestational hypertension (pregnancy-induced hypertension)BP > 140/90 mmHg after the 20th week of gestation. No preexisting hypertension. No proteinuria or end-organ damage.Treatment: antihypertensives (a- methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks.Preeclampsia- Defined as hypertension (> 140/90 mmHg) and proteinuria (> 300 mg/24 hr) after 20th week of gestation to 6 weeks postpartum (< 20 weeks suggests molar pregnancy).Severe features include BP > 160/110 mmHg with or without end-organ damage, e.g., headache, scotoma, oliguria,*AST/ ALT, thrombocytopenia.- Caused by abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.- Incidence<<in patients with preexisting hypertension, diabetes chronic renal disease, or autoimmune disorders.- Complications: placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampsia.Antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild), IV magnesium sulfate to prevent seizure.EclampsiaPreeclampsia + maternal seizures. Maternal death due to stroke*intracranial hemorrhage or ARDS.Antihypertensives, IV magnesium sulfate, immediate delivery.