In a patient with eclampsia who has received a 4 g loading dose of magnesium sulfate IV and has a second convulsion 20 minutes later, the recommended immediate management per Pritchard's protocol is:
- A An additional 2 g magnesium sulfate IV given slowly ✓
- B Switch to diazepam 10 mg IV
- C Phenytoin 15 mg/kg loading dose IV
- D Increase maintenance magnesium to 3 g/hour
Correct answer: A. An additional 2 g magnesium sulfate IV given slowly
Explanation
Per Pritchard's protocol, if eclamptic seizures recur despite adequate magnesium sulfate, an additional 2 g magnesium sulfate is given IV slowly (over 3–5 minutes). This additional bolus is safe and usually aborts subsequent seizures. Diazepam is an alternative only when magnesium is unavailable or contraindicated (e.g., myasthenia gravis). Phenytoin is a second-line agent and evidence favours magnesium over phenytoin in eclampsia.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.