A patient develops eclampsia with ongoing seizures despite two doses of IV magnesium sulfate (4g loading + 2g for breakthrough). The next most appropriate anticonvulsant to add is:
- A Diazepam 10 mg IV
- B Phenytoin 18 mg/kg IV ✓
- C Sodium valproate 400 mg IV
- D Levetiracetam 1g IV
Correct answer: B. Phenytoin 18 mg/kg IV
Explanation
In refractory eclampsia not responding to magnesium sulfate, phenytoin (15–18 mg/kg IV at ≤50 mg/min with cardiac monitoring) is the recommended second-line anticonvulsant. Diazepam causes neonatal respiratory depression and is avoided as an add-on in eclampsia management. Sodium valproate is teratogenic and generally contraindicated in pregnancy. Levetiracetam lacks sufficient evidence for eclampsia rescue therapy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.