Best regimen for Eclampsia is :

MgSO4 [Ref: Fernando Arias 3/e p. 420, 421; Dutta ohs 7/e p. 2341 Most effective medicine for the prevention and treatment of seizure activity in patients with preeclampsia and eclampsia is magnesium sulfate Guidelines for intravenous magnesium sulfate administration The most common way to administer magnesium sulfate is by continuous intravenous infusion. Loading dose Loading dose of 6g of magnesium sulfate gives over approximately 20 minutes causes an elevation serum mg++ level to 5-9 mg/c11. After I hour the level drops to 4.5 mg/dl due to renal elimination and intracellular transfer of ion. Maintenance dose (continuous) When the loading dose is followed by continuous infusion of 2g/h the maintenance level of Mg" would be b/w 4-8 mg/dl. Monitoring for magnesium toxicity Magnesium sulfate is not an innocuous drug and it is necessary to carefully monitor the, drug. It may cause decreased myometrial activity, slow cervical dilatation, increased blood loss at delivery, decreased vital capacity, and pulmonary edema. Monitor urinary output Since Mg++ is excreted by kidney monitoring urine output extremely impoant Preeclampsia is associated with frequent decrease in urine output Deep tendon reflexes should be present Disappearance of patellar reflex is impoant because it is the.first signQ of impending toxicity Patellar reflex lost when plasma conc. 8-10 tnEq/L The drug must be discontinued until patellar reflex reappears Pulse oximetry should be 2.96% Pulse oximetry excellent marker of magnesium toxicity Oxygen saturation stas dropping before there is evidence of respiratory distress calcium gluconate is administered to prevent respiratory depression induced by Hypermagnesemia Respiratory rate should be > 14breathes/min Any changes in the above mentioned indices make it necessary to reevaluate the rate of administration.