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Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
For recurrent convulsions, a repeat dose of magnesium sulphate 2 g in 20 ml should be given over 20 minutes, or the infusion rate should be increased to 1.5 g or 2.0 g/hour (7.5–10 ml/hour Infusion). If the woman does not respond to these measures, then she will need thiopentone sodium 250–300 mg IV, muscle relaxants, intubation and assisted ventilation in the intensive care unit. It is important to exclude intracranial haemorrhage in these cases. In the community or in a primary care setting, magnesium sulphate can also be administered intramuscularly as a loading dose of 10 g (5 g on each buttock) followed by 5 g every 4 hours, until the woman reaches a tertiary care centre. Magnesium sulphate should be continued for 24 hours following delivery or following the last seizure, whichever occurs later. The therapeutic range of serum magnesium is 2–3 mmol/L and although not routinely monitored, the serum magnesium level may need to be checked if there is uncertainty about overdose.
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Tocolytic agents have been used to decrease uterine activity when preterm labour is likely. Various drugs have been used, including beta-mimetics [31], calcium channel blockers [32] and magnesium sulphate [33]. Beta-mimetics (such as ritrodrine) are effective in prolonging pregnancy for up to 48 hours but not longer [31]; this intervention may be beneficial to allow time for postnatal glucocorticoids to have effect [7] or to allow transfer to a tertiary perinatal centre for delivery. Calcium channel blockers appear to be more effective than beta-mimetics and they are effective in combination with prenatal glucocorticoids in reducing RDS (RR 0.63; 95% Cl 0.46–0.88) [32]. Magnesium sulphate, however is ineffective and also has the adverse effect of increased neonatal and paediatric mortality [33].
Contrast enhancement agents and radiopharmaceuticals
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Barium sulphate is an inorganic compound with the chemical formula BaSO4. It occurs in the mineral barite which, when mined, is the commercial source of barium (Fig. 2.18a). Preparations are available either as colloidal barium sulphate, which comprises a suspension of fine barium particles that stay evenly distributed, or more commonly as high-density barium sulphate, which comprises microscopically fine particles of varying size. It is frequently used as a radiocontrast material in medical imaging due to its very high atomic mass and its ability to attenuate X-ray photons. It is most commonly used in imaging of the GI tract (Fig. 2.18b) and can either be administered orally as barium meals and barium swallows, or rectally via rectal catheters for barium enema examinations.
Low-dose of magnesium sulfate solution was not inferior to standard regime of polyethylene glycol for bowel preparation in elderly patients: a randomized, controlled study
Published in Scandinavian Journal of Gastroenterology, 2023
Fulin Ge, Xiaoyu Kang, Zeyu Wang, Hailan Zhu, Liang Liao, Ming Wang, Jianjun Jia, Lijun Lou, Xuegang Guo, Yanglin Pan, Jun Wan
Hyperosmotic formulations of poorly absorbed magnesium and sulfates cause watery diarrhea by hyperosmotic action of the poorly absorbed purgative, which can result in volume depletion in the meantime. Sulfate formulation is regarded as safe for bowel preparation in animals [29] and in human studies [23], Besides, Kwak et al. found insignificant changes in terms of renal toxicity and electrolyte disturbance in elderly patients [30]. Furthermore, no serious adverse events were reported. In the current study, we also found insignificant changes between the MSS group and the standard PEG group with regard to renal function and several electrolytes (e.g., sodium, chlorine, calcium and phosphate). Although a slight increase in serum magnesium (0.12 ± 0.23) was observed in patients taking MSS, the clinical significance may be trivial. Taken together, these results suggest magnesium sulfates formulation may be considered an appropriate option for bowel cleansing in elderly patients.
Does hydroxychloroquine still have any role in the COVID-19 pandemic?
Published in Expert Opinion on Pharmacotherapy, 2021
William HK Schilling, Nicholas J White
Hydroxychloroquine, in which one ethyl group in the alkyl side chain is hydroxylated, was synthesized in 1946. Hydroxychloroquine was shown to have equivalent antimalarial activity and to be slightly less toxic in experimental animals [20]. It was developed more for its use in rheumatological conditions [21]. Initially, both chloroquine and hydroxychloroquine were used to treat rheumatoid arthritis, systemic lupus erythematosus and other rheumatological diseases, but in recent years, hydroxychloroquine has predominated. Hydroxychloroquine is generally considered to be slightly safer than chloroquine [20] although the evidence for this is not strong. There is extensive experience with long-term use mainly in the 3–6 mg base/kg day range (corresponding to adult doses of 155 to 310 mg given as 200 or 400 mg of sulfate salt). Daily doses up to 620 mg base (800 mg salt) have been used.
Iron deficiency anemia in males: a dosing dilemma?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abu Baker Sheikh, Nismat Javed, Zainab Ijaz, Venus Barlas, Rahul Shekhar, Blavir Rukov
Despite this factor, the routine practice is to address the amount of elemental iron needed to correct the anemia. The adult dose of elemental iron is 150 to 200 mg daily for 3 months. Oral ferrous sulfate is the most commonly used formulation. The quantity of elemental iron in one 325 mg tablet is about 65 mg; therefore, the oral form is recommended for use every eight hours [15]. In that case, the total amount supplied to the body in one day would be 195 mg. However, only 2% to 13% of the supplied elemental iron is absorbed with food, and 5% to 28% is absorbed without food [16]. Even if maximal absorption rates were achieved, the additional requirement to correct anemia would still not be met. However, it was found that when the total amount of oral ferrous sulfate prescribed in a day increased, it was associated with adverse effects such as nausea, vomiting, tarry stools, dose-related constipation, and taste changes [17]. These adverse effects can cause non-compliance in many patients.