Symptomatic hypocalcemia after tocolytic therapy with magnesium sulfate and nifedipine
Symptomatic hypocalcemia after tocolytic therapy with magnesium sulfate and nifedipine
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DOI：
10.1016/j.ajog.2004.02.050
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发表时间：
2004-06-01
影响因子：
9.8
通讯作者：
Schwartz, ML
中科院分区：
文献类型：
--
作者：
Koontz, SL;Friedman, SA;Schwartz, ML
目的：在这项研究中，我们提出了2例，并评估了硫酸镁单独或联合使用硝苯地平治疗后的症状性低钙血症的证据。研究设计：病例报告，如下面的一个，和文献综述。一位25岁的孕妇在妊娠33周时出现晚期早产。患者接受硫酸镁治疗，随后接受硝苯地平治疗，并在硫酸镁停药后12小时发生双侧手部挛缩。总血清钙为5.4 mg/dL。一名35岁孕妇在妊娠26周时出现胎膜破裂，并接受硫酸镁治疗，直到因肺水肿而提前停止。20小时后，她出现双侧手部挛缩;总血清钙为5.9 m/dL。两名患者的症状解决与葡萄糖酸钙therapy.Results：低钙血症是一个公认的硫酸镁输注的并发症。这是Medline检索确定的第5和第6例症状性病例报告。我们的第一例是唯一的报告，其中随后使用硝苯地平可能是一个因素。很少有报道与硫酸镁和硝苯地平的联合或序贯使用的可能的毒性：明显的低钙血症是明确与硫酸镁输注，可能是剂量相关的，并可能出现后，停止硫酸镁治疗。此外，虽然硫酸镁和硝苯地平协同毒性的证据很少，但当这些药物一起使用时应谨慎。(C)2004年爱思唯尔公司All rights reserved.
Objectives: In this study, we presented 2 cases and evaluated the evidence for symptomatic hypocalcemia after treatment with magnesium sulfate alone or combined with use of nifedipine.Study design: Case reports, such as the one that follows, and literature review were used. A 25-year-old gravida presented at 33 weeks' gestation with advanced preterm labor. She received magnesium sulfate followed by nifedipine and experienced bilateral hand contractures 12 hours after discontinuation of magnesium sulfate. Total serum calcium was 5.4 mg/dL. A 35-year-old gravida presented at 26 weeks' gestation with ruptured membranes and received magnesium sulfate until it was discontinued prematurely because of pulmonary edema. Twenty hours later she experienced bilateral hand contractures; total serum calcium was 5.9 m/dL. Symptoms for both patients resolved with calcium gluconate therapy.Results: Hypocalcemia is a well-recognized complication of magnesium sulfate infusion. These are the fifth and sixth symptomatic case reports, as identified by Medline Search. Our first case is the only report in which the subsequent use of nifedipine may have been a factor. Little has been reported on the possible toxicity associated with the combined or sequential use of magnesium sulfate and nifedipine.Conclusion: Marked hypocalcemia is clearly associated with magnesium sulfate infusion, is likely dose related, and may appear after discontinuation of magnesium sulfate therapy. Moreover, while the evidence for synergistic toxicity of magnesium sulfate and nifedipine is sparse, caution is advised when these agents are used together. (C) 2004 Elsevier Inc. All rights reserved.