Abstract
Evidence based guidelines regarding the use of magnesium sulfate in tetanus is lacking. Hence, our objective was to compare two infusion doses of magnesium sulfate to control the tetanic spasms. Data of 14 adult male patients admitted in the intensive care unit were retrieved. Twelve adult ventilated patients received magnesium infusion as an adjunct to diazepam therapy to control tetanic spasms. We retrospectively divided them into two groups for comparison. Group 1 patients (n=7) received a smaller dose (<1 g.h(-1)) than group 2 (n=5) (1.5 to 2 g.h(-1)). The duration of symptoms before arrival to hospital was significantly longer in group 1 than group 2. The Ablett severity grade was II in three patients in group 1 and III in all patients of group 2. In Ablett severity grade III patients, the diazepam dose used was significantly higher in group 1 (n=4) (292±48 mg.d(-1)) than group 2 (n=3) (106±9 mg.d(-1)) as magnesium infusion dose was restricted due to hypotension in group 1. Amongst the patients who received MgSO(4) for ≥10 days, the requirement of diazepam was significantly reduced in the second week (174.1±59.2 mg/d) than the first week (325.4±105.9 mg.d(-1)) of infusion in group 2 (n=4) but not in group 1 patients (n=4). The larger dose of MgSO(4) infusion was titrated to control tetanic spasms as an adjunct to diazepam in select group of patients without hypotension. Uncontrolled hypotension, cardiac arrhythmia and renal failure were the factors to limit its infusion dose.
Highlights
Evidence based guidelines regarding the use of magnesium sulfate in tetanus is lacking
Out of the 14 patients transferred to intensive care unit (ICU) for mechanical ventilation, two patients did not receive magnesium therapy as one died within two hours of ICU admission
The dose of magnesium infusion in these four patients requiring larger amount of diazepam in group 1 could not be increased as they developed significant hypotension and cardiac arrhythmia
Summary
Evidence based guidelines regarding the use of magnesium sulfate in tetanus is lacking. Tetanus is resurging globally due to rise in acquired immunodeficiency syndrome, use of immunosuppressive drugs and increased migration of the unimmunized population.[1] Its management is challenging because of uncertainty about the optimum care of the respiratory compromise and the cardiovascular instability.[2] and bradyarrythmia.[5] Magnesium sulfate has been investigated as a therapeutic option in variable infusion doses ranging from 80 mg to 4 gm per hour.[1,6,7,8] Since there is no report on the comparison of different infusion doses, we carried out this retrospective study to compare the outcome of the two different infusion doses used in our intensive care unit (ICU). Magnesium sulfate has been reported for the treatment of tetanus since 1906.3 It controls spasms and the associated sympathetic over activity, minimizes the use of artificial ventilation and sedation.[4] it can cause muscle weakness, hypotension
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