Document Detail

Symptomatic hypocalcemia after tocolytic therapy with magnesium sulfate and nifedipine.
MedLine Citation:
PMID:  15284796     Owner:  NLM     Status:  MEDLINE    
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.
Stephanie L Koontz; Steven A Friedman; Martin L Schwartz
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  190     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-07-30     Completed Date:  2004-08-19     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1773-6     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA.
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MeSH Terms
Calcium Gluconate / therapeutic use
Gestational Age
Hypocalcemia / chemically induced*,  physiopathology
Magnesium Sulfate / adverse effects*,  therapeutic use
Maternal Age
Nifedipine / adverse effects*,  therapeutic use
Obstetric Labor, Premature / drug therapy*,  prevention & control
Pregnancy Outcome*
Pregnancy, High-Risk
Risk Assessment
Severity of Illness Index
Tocolysis / adverse effects*,  methods
Treatment Outcome
Reg. No./Substance:
21829-25-4/Nifedipine; 299-28-5/Calcium Gluconate; 7487-88-9/Magnesium Sulfate

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