From the Guidelines
Eclampsia treatment requires immediate intervention with magnesium sulfate as the first-line medication to prevent and control seizures, as consistently recommended by recent guidelines, including those published in 2022 1. The standard loading dose is 4-6g IV over 15-20 minutes, followed by a maintenance infusion of 1-2g per hour for 24 hours after the last seizure. If seizures persist despite magnesium therapy, additional anticonvulsants such as diazepam (5-10mg IV) or lorazepam (2-4mg IV) may be administered. Blood pressure control is essential using medications like labetalol (20-80mg IV every 10-30 minutes) or hydralazine (5-10mg IV every 20 minutes) to maintain systolic pressure below 160mmHg and diastolic below 110mmHg, as recommended by the European Heart Journal in 2019 1. Some key points to consider in the treatment of eclampsia include:
- Definitive treatment requires delivery of the baby, regardless of gestational age, once the mother is stabilized, as emphasized in the guidelines for hypertensive disorders of pregnancy 1.
- Close monitoring is necessary during treatment, including respiratory rate, deep tendon reflexes, urine output, and serum magnesium levels, as magnesium toxicity can cause respiratory depression.
- Calcium gluconate (1g IV) should be available as an antidote for magnesium toxicity. This comprehensive approach addresses the underlying pathophysiology of eclampsia, which involves cerebral vasospasm, endothelial damage, and increased neuronal excitability, and is supported by the most recent and highest quality studies, including a systematic review of international clinical practice guidelines for pregnancy hypertension published in 2022 1 and a study on the management of hypertensive emergencies published in 2019 1.
From the FDA Drug Label
In Pre-eclampsia or Eclampsia In severe pre-eclampsia or eclampsia, the total initial dose is 10 to 14 g of magnesium sulfate. Intravenously, a dose of 4 to 5 g in 250 mL of 5% Dextrose Injection, USP or 0. 9% Sodium Chloride Injection, USP may be infused. Simultaneously, IM doses of up to 10 g (5 g or 10 mL of the undiluted 50% solution in each buttock) are given Alternatively, the initial IV dose of 4 g may be given by diluting the 50% solution to a 10 or 20% concentration; the diluted fluid (40 mL of a 10% solution or 20 mL of a 20% solution) may then be injected IV over a period of three to four minutes Subsequently, 4 to 5 g (8 to 10 mL of the 50% solution) are injected IM into alternate buttocks every four hours as needed, depending on the continuing presence of the patellar reflex and adequate respiratory function. Alternatively, after the initial IV dose, some clinicians administer 1 to 2 g/hour by constant IV infusion. Therapy should continue until paroxysms cease A serum magnesium level of 6 mg/100 mL is considered optimal for control of seizures. A total daily (24 hr) dose of 30 to 40 g should not be exceeded.
The treatment for eclampsia is magnesium sulfate administered via IV or IM injection. The recommended initial dose is 10 to 14 g, with IV doses ranging from 4 to 5 g and IM doses of up to 10 g. The dose may be repeated every 4 hours as needed, with a maximum daily dose of 30 to 40 g. The goal is to achieve a serum magnesium level of 6 mg/100 mL to control seizures 2.
From the Research
Treatment for Eclampsia
The treatment for eclampsia, a severe complication of preeclampsia, typically involves the use of magnesium sulfate (MgSO4) as the primary agent for preventing seizures and managing the condition [ 3 ].
Administration of Magnesium Sulfate
Magnesium sulfate can be administered through either intramuscular or intravenous routes [ 3 ]. The intramuscular regimen often consists of a 4 g intravenous loading dose, followed by 10 g intramuscularly and then 5 g intramuscularly every 4 hours in alternating buttocks. The intravenous regimen involves a 4 g dose, followed by a maintenance infusion of 1 to 2 g/h by controlled infusion pump.
Efficacy of Magnesium Sulfate
Studies have shown that magnesium sulfate is more effective than phenytoin in reducing the recurrence of seizures in women with eclampsia [ 4, 5 ]. Magnesium sulfate has also been associated with a reduced risk of maternal mortality, although this difference is not always statistically significant [ 4, 5 ]. Additionally, magnesium sulfate may improve outcomes for the baby, including fewer admissions to special care baby units and reduced risk of death or prolonged stay in these units [ 4, 5 ].
Monitoring and Safety
Monitoring for magnesium toxicity is crucial, with signs including loss of patellar reflex, respiratory depression, and cardiac conduction alterations [ 3 ]. The use of magnesium sulfate should be carefully managed, especially in low-income settings, where resources may be limited [ 6 ]. Clinical monitoring of respiration, tendon reflexes, and urine output is sufficient for detecting magnesium toxicity, and serum monitoring is not necessary [ 6 ].
Key Points
- Magnesium sulfate is the primary treatment for eclampsia.
- It can be administered intramuscularly or intravenously.
- Magnesium sulfate is more effective than phenytoin in preventing recurrent seizures.
- Careful monitoring for magnesium toxicity is essential.
- Magnesium sulfate may improve maternal and fetal outcomes.