Abstract
BackgroundMagnesium sulfate (MgSO4) is the standard drug for eclampsia prophylaxis and treatment. In China, the effective therapeutic serum magnesium level is 1.8–3.0 mmol/L. There is little information on how to achieve and maintain effective therapeutic concentrations. This study aimed to investigate risk factors for sub-therapeutic serum concentrations of MgSO4 in patients with severe preeclampsia.MethodsPatients with severe preeclampsia who received MgSO4 intravenous infusion were retrospectively reviewed. The maternal demographic characteristics, regimens for the administration of MgSO4, and lab test results of patients were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were conducted for the risk factors influencing the serum magnesium concentration.ResultsA total of 93 patients with severe preeclampsia were included in the study. 52 (55.91%) patients did not attain therapeutic serum magnesium levels. A multivariate logistic regression analysis identified creatinine clearance (Ccr), whether the loading dose was given, and measurement time of serum magnesium concentration (referring to the time from start of MgSO4 infusion to blood draw for serum sampling) as independent risk factors for sub-therapeutic serum magnesium concentration (P < 0.05). ROC curve analysis indicated that the continuous variable Ccr had a significant predictive value for the serum magnesium concentration, which resulted in a cutoff point of 133 mL/min; while measurement time had limited predictive value, with cutoff point of 2.375 h.ConclusionsCcr, whether the loading dose was given, and measurement time were independent risk factors for sub-therapeutic serum magnesium concentration. A loading dose of MgSO4 everytime before the maintenance dose, as well as the duration of MgSO4 maintenance dose of more than 2.375 h are recommended for all the patients with severe PE. Routine evaluation of serum magnesium levels is a recommended practice for women with severe PE and whose Ccr is ≥133 mL/min.
Highlights
Magnesium sulfate (MgSO4) is the standard drug for eclampsia prophylaxis and treatment
Inclusion criteria were: (1) singleton pregnancy, (2) aged 18–45 years, (3) the baseline serum magnesium concentrations were measured before IV infusion of MgSO4, and (4) serum magnesium levels were measured during IV infusion of a maintenance dose
We collected data on maternal age, gestational age, height and weight, creatinine clearance (Ccr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, baseline serum magnesium concentrations, whether the loading dose was given, and measurement time
Summary
Magnesium sulfate (MgSO4) is the standard drug for eclampsia prophylaxis and treatment. In China, the effective therapeutic serum magnesium level is 1.8–3.0 mmol/L. This study aimed to investigate risk factors for sub-therapeutic serum concentrations of MgSO4 in patients with severe preeclampsia. Magnesium sulfate (MgSO4) is the preferred pharmacological intervention to treat severe PE because it can prevent the recurrent seizures of eclampsia [2, 3]. While in China, optimal control of convulsions is thought to be most effective with therapeutic serum magnesium level at 1.8–3.0 mmol/L. There is little information on whether serum magnesium level can reach the effective therapeutic concentration and the influencing factors in patients with severe PE in China. The clinical data of 93 patients with severe PE treated with MgSO4 were analyzed retrospectively to explore the risk factors for serum magnesium not reaching the therapeutic concentration
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