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Marked hypocalcemia after tocolytic magnesium sulphate therapy
Anwar H Nassar1, Ibrahim Salti, Nisrine N Makarem
1Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
American Journal of Perinatology
|September 14, 2007
Summary
Magnesium sulfate (MgSO4) therapy for preterm labor can cause severe hypocalcemia, even with short durations. This case highlights the potential need for routine calcium monitoring during MgSO4 treatment.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pharmacology
Background:
- Magnesium sulfate (MgSO4) is a commonly used tocolytic agent to manage preterm labor.
- Symptomatic hypocalcemia is an infrequently reported complication of MgSO4 therapy.
Observation:
- A 38-year-old woman at 24 3/7 weeks gestation presented with preterm labor and received MgSO4.
- Twenty hours into therapy, she developed chest pain and was found to have severe hypocalcemia (total serum calcium 5.5 mg/dL) despite therapeutic serum magnesium levels.
- Laboratory findings included low serum uric acid and phosphate, and elevated 24-hour urine calcium excretion.
Findings:
- The patient's hypocalcemia and other laboratory abnormalities resolved postpartum.
- Urine calcium levels normalized on postpartum day 2.
- This case demonstrates that even short courses of MgSO4 can precipitate severe hypocalcemia.
Implications:
- Routine monitoring of serum calcium levels may be warranted in patients receiving MgSO4 for tocolysis.
- Clinicians should be aware of the potential for severe hypocalcemia as a complication of MgSO4 therapy.
- Further studies are needed to establish guidelines for calcium monitoring during MgSO4 treatment.
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