Magnesium: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
Can give up to 10 gm IM (5 g in each buttock)
Observe for loss of reflexes, respiratory depression
Must adjust dose in patients with renal failure
If seizures recur:
Consider alternative diagnosis
Consider other anticonvulsant drugs
Lorazepam, diazepam, phenytoin, levetiracetam
Contraindications to magnesium:
Severe renal failure
Pulmonary edema
Myasthenia gravis
Can give up to 10 gm IM (5 g in each buttock)
Observe for loss of reflexes, respiratory depression
Must adjust dose in patients with renal failure
Consider alternative diagnosis
Consider other anticonvulsant drugs
Lorazepam, diazepam, phenytoin, levetiracetam
Lorazepam, diazepam, phenytoin, levetiracetam
Severe renal failure
Pulmonary edema
Myasthenia gravis
Lower to Sys 130-150, dia 80-100
Labetalol
Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
Option 2: Initial 20mg; then IV infusion of 1-2mg/min
Hydralazine
5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
Labetalol
Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
Option 2: Initial 20mg; then IV infusion of 1-2mg/min
Hydralazine
5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
Option 2: Initial 20mg; then IV infusion of 1-2mg/min
5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
See status epilepticus
Plan appropriately for delivery
Eclampsia
Preeclampsia
Epileptic seizure
Hyperemesis gravidarum
First-time seizure
Postpartum hemorrhage
Seizure with known seizure disorder
Comorbid diseases in pregnancy