C/I of Magnesium in Eclampsia

Q: Mention at least one disease where Magnesium is contraindicated in eclampsia?

Answer: Myasthenia gravis

High-dose magnesium has remained the standard of care for eclampsia over the decades, and under time pressure, it is difficult to recall magnesium's contraindications, particularly in patients with a history of myasthenia gravis. Magnesium can precipitate a severe myasthenic crisis.

Similarly, magnesium should be used with caution in the following situations:

• Severe renal failure (lack of excretion)
• Severe Coronary Artery Disease (CAD)
• Heart blocks
• Myocardial disease
• Hypocalcemia (exacerbates the situation)

#ob-gyn

#electrolytes

References:

1. Lake AJ, Al Khabbaz A, Keeney R. Severe Preeclampsia in the Setting of Myasthenia Gravis. Case Rep Obstet Gynecol. 2017;2017:9204930. doi: 10.1155/2017/9204930. Epub 2017 Feb 9. PMID: 28280642; PMCID: PMC5322431.

2. Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor E. An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth. 2013 Feb 5;13:34. doi: 10.1186/1471-2393-13-34. PMID: 23383864; PMCID: PMC3570392.

3. Abdulhadi B, Agarwal M. The Unusual Suspect: Hypocalcemia in Preeclampsia After Magnesium Infusion. J Endocr Soc. 2021 May 3;5(Suppl 1):A227. doi: 10.1210/jendso/bvab048.461. PMCID: PMC8089210.