Eclampsia Flashcards
What is eclampsia defined as?
Eclampsia is defined as the development of seizures in association with pre-eclampsia.
What is pre-eclampsia defined as?
Pre-eclampsia is defined as a condition seen after 20 weeks gestation with pregnancy-induced hypertension and proteinuria.
What is the primary treatment used to prevent and treat seizures in eclampsia?
Magnesium sulphate is used to both prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop.
When should magnesium sulphate be administered?
Magnesium sulphate should be given once a decision to deliver has been made.
What is the initial IV bolus dose of magnesium sulphate for eclampsia?
In eclampsia, an IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g/hour.
What should be monitored during magnesium sulphate treatment?
Urine output, reflexes, respiratory rate, and oxygen saturations should be monitored during treatment.
What is the first-line treatment for magnesium sulphate-induced respiratory depression?
Calcium gluconate is the first-line treatment for magnesium sulphate-induced respiratory depression.
How long should magnesium sulphate treatment continue?
Treatment should continue for 24 hours after the last seizure or delivery.
What is an important aspect of treating severe pre-eclampsia/eclampsia?
Fluid restriction is an important aspect to avoid the potentially serious consequences of fluid overload.
summarise eclampsia
Eclampsia
Eclampsia may be defined as the development of seizures in association pre-eclampsia. To recap, pre-eclampsia is defined as:
condition seen after 20 weeks gestation
pregnancy-induced hypertension
proteinuria
Magnesium sulphate is used to both prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop. Guidelines on its use suggest the following:
should be given once a decision to deliver has been made
in eclampsia an IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour
urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment
respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression
treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)
Other important aspects of treating severe pre-eclampsia/eclampsia include fluid restriction to avoid the potentially serious consequences of fluid overload
A 45-year-old G3P2 is brought to the emergency department by the paramedics after she suffered a generalized tonic-clonic seizure. Her blood pressure was found to be 190/125 mmHg. The paramedics obtained IV access and also administered intramuscular magnesium sulfate to treat her seizures. She was then put on an IV infusion of magnesium sulfate. On her arrival to the accident and emergency department, her respiratory rate is found to be 10 breaths per minute. You suspect this might be a case of respiratory depression secondary to magnesium sulfate.
What is the drug of choice for reversing respiratory depression caused by magnesium sulphate?
Bicarbonates
Flumazenil
Calcium gluconate
Naloxone
Zopiclone
Calcium gluconate
Calcium gluconate is first-line treatment for magnesium sulphate induced respiratory depression
Bicarbonates are used to prevent cardiovascular complications as a result of tricyclic antidepressants overdose.
Flumazenil is used in benzodiazepine overdose.
Calcium gluconate is the choice of drug for reversing respiratory depression caused by magnesium sulfate.
Naloxone is used to reverse respiratory depression secondary to opioid overdose.
Zopiclone is a hypnotic agent used to treat insomnia.
A 29-year-old woman presents to the emergency department with a headache that has progressed over the day. She is 34 weeks pregnant but has a poor history of attending her antenatal appointments. After triage, an initial set of observations revealed a heart rate of 89bpm, a blood pressure of 174/101mmHg and a temperature of 37.1ºC. She quickly deteriorates and begins to have a seizure shortly after triage. Eclampsia is suspected and she receives intravenous magnesium sulphate.
What signs should be most closely monitored following the administration of this medication?
Blood pressure + heart rate
Blood pressure + pupil size
Heart rate + reflexes
Respiratory rate + reflexes
Urine output + pupil size
Magnesium sulphate - monitor reflexes + respiratory rate
Respiratory rate + reflexes is the correct answer. Respiratory depression is a recognised complication of magnesium sulphate therapy, making it imperative to monitor the respiratory rate when administering this medication. Furthermore, hyporeflexia is a characteristic sign of hypermagnesaemia, underlining the importance of reflex assessment in evaluating serum magnesium levels. In cases of respiratory depression, management should include the administration of intravenous calcium gluconate and cessation of magnesium sulphate.
Blood pressure + heart rate is incorrect. Although monitoring blood pressure is crucial during magnesium sulphate therapy due to the potential for hypotension secondary to magnesium toxicity, heart rate monitoring does not have the same clinical relevance as respiratory rate and reflexes. The latter are more specific indicators of hypermagnesaemia and are therefore more valuable in guiding the administration of magnesium sulphate.
Blood pressure + pupil size is incorrect. While it is essential to monitor blood pressure during treatment with magnesium sulphate because it can cause hypotension, assessing pupil size does not hold as much significance as monitoring changes in reflexes and respiratory rate, which are directly affected by high serum magnesium levels.
Heart rate + reflexes is incorrect. Although hypermagnesaemia may result in hyporeflexia—highlighting the necessity to monitor reflexes during treatment with magnesium sulphate—the importance of heart rate monitoring is less than that for other signs such as blood pressure and respiratory rate, which are also influenced by elevated serum magnesium.
Urine output + pupil size is incorrect as these parameters are less critical when assessing for hypermagnesaemia in patients undergoing magnesium sulphate therapy. Key clinical signs that should be monitored include respiratory rate, reflexes, and blood pressure.
A woman with known pregnancy-induced hypertension presents at 36 weeks gestation with chest pain, leg swelling, and a headache. A urine dip confirms proteinuria.
Before management can be commenced the patient collapses and starts to have a tonic-clonic seizure.
What adverse effect should be monitored for while providing the first-line treatment indicated?
Blood pressure
Cardiac monitoring
Potassium level
Respiratory rate
Temperature
Respiratory rate
Magnesium sulphate - monitor reflexes + respiratory rate
The patient has presented with eclampsia having developed seizures with pre-eclampsia features including pregnancy-induced hypertension and proteinuria. Magnesium sulphate should be used as a treatment for eclampsia whilst a delivery plan is made. A well-recognised side effect of magnesium sulphate treatment is respiratory depression and for this reason, the patient’s respiratory rate must be monitored.
Although a treatment for eclampsia, magnesium sulphate has little effect on a patient’s blood pressure and therefore does not further complications of hypertension or result in hypotension. Although blood pressure should be monitored it is not to identify adverse effects of magnesium sulphate treatment.
Magnesium sulphate can be used as an antiarrhythmic agent for certain cardiac dysrhythmias as well as a treatment for eclampsia. Cardiac issues resulting from magnesium sulphate treatment are therefore rare and cardiac monitoring is not required to identify potential side effects.
Hypokalaemia is frequently associated with magnesium deficiency and therefore this should be checked for in these patients. The use of magnesium sulphate however is not associated with significant alterations in potassium levels and therefore it is not required to monitor potassium levels when providing magnesium treatment.
Magnesium sulphate is not associated with significant changes in temperature and so again although it should be monitored in all unwell patients, it is not required to specifically monitor for adverse effects.
