Department of Obstetrics and Gynecology, Alborz University of Medical Sciences, Karaj, Iran.
Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Int J Gynaecol Obstet. 2022 Dec;159(3):938-943. doi: 10.1002/ijgo.14296. Epub 2022 Jun 19.
To evaluate possible interactions of magnesium sulfate-the drug of choice in the management of pre-eclampsia/eclampsia-in response to a few case reports that revealed maternal electrolyte disturbances, especially symptomatic changes, following magnesium sulfate administration in pre-eclampsia.
Prospectively, women with pre-eclampsia were given 4 g of intravenous magnesium sulfate followed by a 2 g/h infusion up to 24 h after delivery. Sequential blood samples were drawn from each patient and used to measure the serum levels of sodium, potassium, calcium, phosphorus, magnesium, and parathyroid hormone.
A total of 30 pregnant women with pre-eclampsia were evaluated. They were aged between 20 and 41 years with median gestational age of 37.6 (interquartile range 35.4-38.9) weeks. Only five patients reached the therapeutic window of magnesium in at least one of our measuring intervals during magnesium sulfate infusion. Plasma magnesium concentrations increased significantly during magnesium sulfate administration and dropped during the next 12 and 24 h after infusion discontinuation (P < 0.05). Fifteen of 30 (50%) patients developed asymptomatic hypocalcemia, mainly at hour 24 of infusion. Negative moderate correlations were detected between the calcium and magnesium concentrations at 12 and 24 hours of infusion (ρ = -0.390, P = 0.044 and ρ = 0.315, P = 0.096, respectively). None of the patients with hypocalcemia reached the therapeutic level of magnesium or experienced parallel hyperphosphatemia. Eleven of 30 (36.6%) patients developed hyperphosphatemia mainly at 2 and 12 h of magnesium sulfate infusion.
Our study implies that magnesium sulfate could cause hypermagnesemia-induced hypocalcemia in women with pre-eclampsia, independent from parathyroid hormone. The negative correlations between calcium and magnesium concentrations could be indicative of dose-dependent associations between serum magnesium level and degree of hypocalcemia in our study.
评估硫酸镁（子痫前期/子痫治疗的首选药物）可能的相互作用，因为少数病例报告显示，子痫前期患者在接受硫酸镁治疗后会出现母体电解质紊乱，特别是有症状的变化。
前瞻性地，给患有子痫前期的女性静脉注射 4g 硫酸镁，然后以 2g/h 的速度输注，持续 24 小时，直至分娩后。从每位患者中抽取连续的血样，并用于测量血清中的钠、钾、钙、磷、镁和甲状旁腺激素水平。
共评估了 30 名患有子痫前期的孕妇。她们的年龄在 20 至 41 岁之间，中位妊娠年龄为 37.6 周（四分位间距 35.4-38.9 周）。只有 5 名患者在硫酸镁输注期间的至少一个测量间隔内达到了硫酸镁的治疗窗。硫酸镁给药期间，血浆镁浓度显著升高，输注停止后 12 和 24 小时下降（P<0.05）。30 名患者中有 15 名（50%）患者出现无症状性低钙血症，主要发生在输注的第 24 小时。输注后 12 和 24 小时，检测到钙和镁浓度之间存在负中度相关性（ρ=-0.390，P=0.044 和 ρ=0.315，P=0.096）。没有低钙血症患者达到镁的治疗水平，也没有出现平行的高磷血症。30 名患者中有 11 名（36.6%）患者主要在硫酸镁输注后 2 和 12 小时出现高磷血症。
我们的研究表明，镁离子可能会导致子痫前期妇女发生高镁血症诱导的低钙血症，这与甲状旁腺激素无关。钙和镁浓度之间的负相关性可能表明，在我们的研究中，血清镁水平与低钙血症的程度之间存在剂量依赖性关联。
