A 28-year-old eclamptic patient continues to have seizures despite two loading doses of magnesium sulfate. The urine output is 18 mL/hour. What is the NEXT best step?
- A Additional magnesium 2 g IV over 5 minutes; if seizures persist, use IV diazepam or thiopentone ✓
- B Administer IV diazepam 10 mg as rescue anticonvulsant
- C Increase magnesium maintenance infusion to 4 g/hour
- D Check serum magnesium level; if therapeutic, add IV sodium valproate
Correct answer: A. Additional magnesium 2 g IV over 5 minutes; if seizures persist, use IV diazepam or thiopentone
Explanation
For breakthrough eclamptic seizures despite therapeutic magnesium, the WHO/ACOG protocol recommends an additional 2 g magnesium IV over 5 minutes. If seizures persist despite this, IV diazepam or sodium thiopentone with intubation is used. Increasing maintenance infusion does not address acute breakthrough. The reduced urine output (18 mL/hr) requires monitoring for magnesium toxicity, not automatically increasing the dose. Sodium valproate is not the standard backup for eclampsia.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.