Assuntos
Bombas de Infusão , Sulfato de Magnésio/intoxicação , Erros de Medicação , Trabalho de Parto Prematuro/tratamento farmacológico , Tocolíticos/intoxicação , Adulto , Feminino , Humanos , Infusões Intravenosas , Sulfato de Magnésio/administração & dosagem , Trabalho de Parto Prematuro/enfermagem , Gravidez , Tocolíticos/administração & dosagemAssuntos
Sulfato de Magnésio/intoxicação , Erros de Medicação/prevenção & controle , Tocolíticos/intoxicação , Overdose de Drogas , Feminino , Humanos , Erros de Medicação/métodos , Erros de Medicação/enfermagem , Erros de Medicação/estatística & dados numéricos , Trabalho de Parto Prematuro/tratamento farmacológico , Enfermagem Obstétrica , Gravidez , Gestão da SegurançaRESUMO
Two surviving female infants, born from a triplet pregnancy at 30 weeks gestation, were noted to have severe osteopenia and multiple fractures diagnosed at 20 days of age. Their mother had been treated for preterm labor with intravenous magnesium sulfate from week 22 until their birth at 30 weeks gestation. At birth, the triplets exhibited craniotabes with enlarged fontanelles and sutures. All developed Respiratory Distress Syndrome (RDS) and the two surviving infants required prolonged respiratory support. Serum calcium and phosphate levels were normal and alkaline phosphatase levels were increased. The infants were treated with supplements of calcium and phosphorous, with resultant healing of the multiple fractures without deformity. Fetal magnesium toxicity impairs bone mineralization and can lead to serious bone demineralization that may cause fractures in the newborn period that complicate recovery from respiratory disease. Early recognition and treatment may minimize complications related to osteopenia caused by fetal magnesium toxicity.
Assuntos
Desmineralização Patológica Óssea/induzido quimicamente , Feto/efeitos dos fármacos , Fraturas Ósseas/induzido quimicamente , Magnésio/intoxicação , Adulto , Desmineralização Patológica Óssea/diagnóstico por imagem , Evolução Fatal , Feminino , Fêmur/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Recém-Nascido , Injeções Intravenosas , Sulfato de Magnésio/administração & dosagem , Sulfato de Magnésio/intoxicação , Sulfato de Magnésio/uso terapêutico , Masculino , Trabalho de Parto Prematuro/tratamento farmacológico , Gravidez , Radiografia , Costelas/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Tocolíticos/administração & dosagem , Tocolíticos/intoxicação , Tocolíticos/uso terapêutico , TrigêmeosRESUMO
A 31-year-old primigravida with twins had spontaneous rupture of the membranes at 32 weeks' gestation. On admission, because of contractions, the mother was started on tocolytic magnesium sulfate (MgSO4) along with betamethasone and prophylactic antibiotics. About a day later, she was found to have magnesium toxicity. Her serum total magnesium level was 9.0 mg/dl. Tocolysis was immediately discontinued. At cesarean delivery the following day, twin A, a female, died at 30 minutes of age despite a vigorous resuscitation. Although the preceding fetal heart rate patterns had been reassuring and the umbilical blood gases were normal, quite unexpectedly, the Apgar scores were 1/1/0. An autopsy revealed no anatomic abnormalities. Twin B, a female who survived, was also intubated at delivery. During her stay in the Neonatal Intensive Care Unit, she was found to have modestly elevated levels of serum cardiotroponin T. In our opinion, it is probable that the death of twin A can be directly attributed to magnesium sulfate toxicity. Neonatologists who attend deliveries should be aware that unexpected death may occur in babies who were exposed to high doses of tocolytic MgSO4.