Interesting that magnesium sulphate Which is used to treat preeclampsia can cause transient hypotonia in neonates, makes you wonder ....... Hmmmmm......

Magnesium Sulfate
Magnesium sulfate is used to treat pre-eclampsia, eclampsia and preterm labor.
Pre-eclampsia (also known as toxemia and Pregnancy-Induced High Blood Pressure) consists of high blood pressure, protein in the urine and edema (swelling). It can rapidly become severe pre-eclampsia, with very high blood pressure, visual disturbances, failing kidneys and elevated liver enzymes. In rare cases, pre-eclampsia develops into eclampsia, where potentially fatal convulsions occur. It also can become HELLP Syndrome (hemolysis (H), which is the breaking down of red blood cells, elevated liver enzymes (EL), and low platelet count (LP)), which is potentially fatal to both the woman and her baby or babies.
Treating Pre-Eclampsia and Eclampsia
Questions to Discuss with Your Doctor
Preterm labor is defined as contractions and cervical effacement and/or dilation before term.
Treating Preterm Labor
Table and Study Citations for Use in Preterm Labor
Questions to Discuss with Your Doctor
Treating Pre-Eclampsia and Eclampsia
1. Why is magnesium sulfate used for pre-eclampsia and eclampsia?
This drug typically is used in obstetrics to prevent severe pre-eclampsia from becoming eclampsia (life-threatening convulsions). It also is used to stop the convulsions of eclampsia. In the United States, it has been used to treat severe pre-eclampsia for 60 years (Lancet, 1997, Vol. 350, p. 1491) and is FDA-approved for this purpose.
2. How is it administered?
It usually is given to patients through an IV in the hospital, and sometimes it is administered in shots.
A woman experiencing pre-eclampsia may receive a loading (big) dose through an IV of 4 to 6 grams and a continuous dose of 1-2 grams per hour. She may receive these doses before giving birth and sometimes for at least 24 hours after giving birth. If a woman is having convulsions from eclampsia, she may receive a single dose of 4 to 6 grams to try to stop the convulsions.
3. How long do patients take magnesium sulfate?
In severe pre-eclampsia, magnesium sulfate is used for short periods of time (24 to 48 hours) until the baby or babies can be delivered, which is the only "cure" for pre-eclampsia. If the baby or babies will be premature, it can buy enough time to administer drugs to the woman to strengthen the baby's lungs (corticosteroids like betamethasone).
4. a. What are some of the most common side effects of magnesium sulfate?
General muscle weakness
Constipation4. b. What are some of the complications of magnesium sulfate(sometimes occurring with magnesium overdose)?Note: Your doctor can ensure your safety by monitoring you carefully and by making sure your kidneys are fully functioning. This can be done with a blood test. Severe pre-eclampsia sometimes can cause a woman's kidneys to fail, and that can intensify the risk of a magnesium sulfate overdose. A blood test can check the level of magnesium in your body.
Cardiac arrest
Pulmonary edema (lungs fill with fluid; can be fatal)
Chest pain
Cardiac conduction defects
Low blood pressure
Low calcium
Increased urinary calcium
Visual disturbances
Decreased bone density
Respiratory depression (difficulty breathing)
Muscular hyperexcitability
Rare, Severe Complications
Profound muscular paralysis
Paralytic ileus (intestinal obstruction)
Adapted from: Hill, Washington Clark, "Risks and Complications of Tocolysis," Clinical Obstetrics and Gynecology, 1995, Vol. 38, p. 733.
5. Does magnesium sulfate affect my baby or babies?
Yes, it crosses the placenta. After your baby or babies are born, they may have some of it in their blood. Magnesium levels usually return to normal within a few days.
Click here for a list of neonatal side effects.
In the past, magnesium sulfate has been thought to be safe for babies whose mothers take it. However, doctors are debating the significance of one 1997 study that challenges this view. More studies are needed before definite conclusions can be made. In addition, because of the significant risk of developing eclampsia, the benefits of a woman being on magnesium sulfate may outweigh the risks to her and to her baby.
This 1997 study was conducted at the University of Chicago and found an increased number of neonatal deaths in women who took it for preterm labor in comparison to those women who took another preterm labor drug (ritodrine, terbutaline, indomethacin or nifedipine). A second group of women in this study with advanced cervical dilation but not eligible for preterm labor drugs received either a 4 g dose of magnesium sulfate or a placebo (saline). The women who received the magnesium sulfate dose or doses had a higher rate of neonatal deaths (8 deaths out of 75 pregnancies) than the control group (1 death out of 75 pregnancies). The difference was statistically significant. (Mittendorf, Robert et. al, Lancet, Vol. 350, pp. 1517-1518.)
6. Will I be confined to my bed while on magnesium sulfate?
Yes, most women are. Your diet probably will be restricted to fluids because of the risk of vomiting. You may need to use a bedpan or a catheter.
7. Can magnesium sulfate be combined with other drugs?
Magnesium sulfate, when combined with nifedipine, can cause neuromuscular blockade (muscular paralysis). When combined with ritodrine or terbutaline, magnesium sulfate can greatly increase the risk of severe complications - including pulmonary edema and cardiovascular complications. A study of asthmatics found that combining magnesium sulfate and terbutaline increased terbutaline's cardiovascular side effects (Chest, 1994, Vol. 105, pp. 701-705).
8. Does magnesium sulfate work?
A 1998 review concluded that it is effective in preventing convulsions in women who have severe pre-eclampsia and in stopping convulsions in eclamptic women. The review consisted of 19 randomized, controlled trials, five retrospective studies and eight observational reports published in English between 1966 and February 1998. The review also concluded that more research is needed on whether magnesium sulfate is effective for women with mild pre-eclampsia and gestational high blood pressure (Obstetrics and Gynecology, Vol. 92, pp. 883-889).
9. Are there alternatives to magnesium sulfate in treating pre-eclampsia?
Magnesium sulfate is widely used in the United States to prevent convulsions from severe pre-eclampsia. In Europe and Australia, the most popular choices are: diazepam, phenytoin, chlormethiazole and barbituates.


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