Treatment of Severe Preeclampsia With Eclamptic Seizures in Cesarean Delivery With Postoperative Ionized Magnesium Monitoring

Prevention of recurrent eclamptic seizures requires the administration of magnesium sulfate. However, to our knowledge, there are no reports of cases in which the ionized magnesium concentration has been monitored during magnesium sulfate administration to prevent eclampsia. We describe a case in which monitoring of ionized magnesium permitted the use of magnesium sulfate to prevent a third eclamptic seizure. A 31-year-old primigravida with severe preeclampsia and eclampsia underwent emergency cesarean delivery. The patient had a recurrence of seizures intraoperatively. Postoperatively, she was managed with continuous magnesium sulfate infusion under ionized magnesium monitoring at the bedside using a blood gas analyzer in the intensive care unit. This approach might have helped prevent further seizures and complications associated with the administration of magnesium sulfate, such as hypermagnesemia. This case indicates that in the use of magnesium sulfate for patients with preeclampsia, ionized magnesium measurement was used for the rapid determination of magnesium levels.