Serum magnesium levels during magnesium sulfate infusion at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in women with severe preeclampsia: A randomized clinical trial.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
entrez:
9
8
2019
pubmed:
9
8
2019
medline:
4
9
2019
Statut:
ppublish
Résumé
Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia. Nevertheless, the best regimen for protection against eclampsia with minimal side effects remains to be established. This study aimed to compare serum magnesium levels during intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in pregnant and postpartum women with severe preeclampsia. A randomized, triple-blind clinical trial was conducted, comparing serum magnesium levels during the intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose for the prevention of eclampsia in 62 pregnant and postpartum women with severe preeclampsia, 31 in each group. An intravenous loading dose of 6 grams of magnesium sulfate was administered over 30 minutes in both groups. The patients were then randomized to receive a maintenance dose of either 1 or 2 grams/hour for 24 hours. Primary outcomes consisted of serum magnesium levels at the following time points: baseline, 30 minutes, every 2 hours until the end of the first 6 hours, and every 6 hours thereafter until the termination of magnesium sulfate infusion. Side effects, maternal complications, and neonatal outcomes were the secondary outcomes. Serum magnesium levels were higher in the 2-gram/hour group, with a statistically significant difference from 2 hours after the beginning of the magnesium sulfate infusion (P <.05). Oliguria was the most common complication recorded in both groups, with no significant difference between the 2 regimens (RR 0.88; 95% CI: 0.49-1.56; P = .65). No cases of eclampsia occurred. Side effects were more common in the 2-gram/hour group (RR 1.89; 95% CI: 1.04-3.41; P = .02); however, all were mild. There were no differences between the 2 groups regarding neonatal outcomes, except for admission to neonatal intensive care, which was more frequent in the 1-gram/hour group (25% vs 6.3%; P = .04). Magnesium sulfate therapy at the maintenance dose of 1 gram/hour was just as effective as the 2-gram maintenance dose, with fewer side effects.
Sections du résumé
BACKGROUND
BACKGROUND
Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia. Nevertheless, the best regimen for protection against eclampsia with minimal side effects remains to be established. This study aimed to compare serum magnesium levels during intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in pregnant and postpartum women with severe preeclampsia.
METHODS
METHODS
A randomized, triple-blind clinical trial was conducted, comparing serum magnesium levels during the intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose for the prevention of eclampsia in 62 pregnant and postpartum women with severe preeclampsia, 31 in each group. An intravenous loading dose of 6 grams of magnesium sulfate was administered over 30 minutes in both groups. The patients were then randomized to receive a maintenance dose of either 1 or 2 grams/hour for 24 hours. Primary outcomes consisted of serum magnesium levels at the following time points: baseline, 30 minutes, every 2 hours until the end of the first 6 hours, and every 6 hours thereafter until the termination of magnesium sulfate infusion. Side effects, maternal complications, and neonatal outcomes were the secondary outcomes.
RESULTS
RESULTS
Serum magnesium levels were higher in the 2-gram/hour group, with a statistically significant difference from 2 hours after the beginning of the magnesium sulfate infusion (P <.05). Oliguria was the most common complication recorded in both groups, with no significant difference between the 2 regimens (RR 0.88; 95% CI: 0.49-1.56; P = .65). No cases of eclampsia occurred. Side effects were more common in the 2-gram/hour group (RR 1.89; 95% CI: 1.04-3.41; P = .02); however, all were mild. There were no differences between the 2 groups regarding neonatal outcomes, except for admission to neonatal intensive care, which was more frequent in the 1-gram/hour group (25% vs 6.3%; P = .04).
CONCLUSION
CONCLUSIONS
Magnesium sulfate therapy at the maintenance dose of 1 gram/hour was just as effective as the 2-gram maintenance dose, with fewer side effects.
Identifiants
pubmed: 31393402
doi: 10.1097/MD.0000000000016779
pii: 00005792-201908090-00062
pmc: PMC6709127
doi:
Substances chimiques
Magnesium Sulfate
7487-88-9
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16779Références
S Afr Med J. 1994 Sep;84(9):607-10
pubmed: 7839282
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD004661
pubmed: 19160238
Am J Perinatol. 2012 Nov;29(10):795-9
pubmed: 22773290
Semin Perinatol. 2012 Feb;36(1):56-9
pubmed: 22280867
Cochrane Database Syst Rev. 2010 Nov 10;(11):CD000025
pubmed: 21069663
Asia Oceania J Obstet Gynaecol. 1993 Dec;19(4):387-90
pubmed: 8135671
Semin Perinatol. 2009 Jun;33(3):130-7
pubmed: 19464502
Br J Obstet Gynaecol. 1992 Jul;99(7):547-53
pubmed: 1525093
Am J Obstet Gynecol. 2004 Jun;190(6):1520-6
pubmed: 15284724
Am J Obstet Gynecol. 1990 May;162(5):1141-5
pubmed: 2288560
Obstet Gynecol. 2013 Nov;122(5):1122-1131
pubmed: 24150027
Hypertens Pregnancy. 2003;22(3):257-65
pubmed: 14572362
Lancet. 2006 Apr 1;367(9516):1066-1074
pubmed: 16581405
Surg Gynecol Obstet. 1955 Feb;100(2):131-40
pubmed: 13238166
Cochrane Database Syst Rev. 2010 Aug 04;(8):CD007388
pubmed: 20687086
Clin Pharmacokinet. 2000 Apr;38(4):305-14
pubmed: 10803454
BJOG. 2013 Jun;120(7):894-900
pubmed: 23530757
PLoS One. 2014 May 13;9(5):e97401
pubmed: 24825164
BJOG. 2016 Feb;123(3):356-66
pubmed: 26599617
Int J Gynaecol Obstet. 2009 Feb;104(2):90-4
pubmed: 19027902
J Med Assoc Thai. 2013 Apr;96(4):395-8
pubmed: 23691692
Br J Obstet Gynaecol. 1983 Jan;90(1):34-9
pubmed: 6821668
Obstet Gynecol. 2009 Jun;113(6):1327-1333
pubmed: 19461430
Am J Obstet Gynecol. 1978 Jul 15;131(6):591-7
pubmed: 686045
BMC Pregnancy Childbirth. 2013 Feb 05;13:34
pubmed: 23383864
Lancet. 2010 Aug 21;376(9741):631-44
pubmed: 20598363