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Hyperkalemia Associated with Prolonged Magnesium Sulfate Administration in Preeclampsia
妊娠毒血症患者長期使用MgSO4併發高血鉀症
摘要
Background: Although magnesium sulfate (MgSO4) has been effectively employed to treat toxemia, hyperkalemia associated with its prolonged administration has not been well recognized. We reviewed retrospectively the records of women with preeclampsia who received prolonged MgSO4 administration to assess serum potassium (K+) levels. Methods: Over a 3-year period, 587 women with preeclampsia were treated with MgSO4. Excluding patients with pre-existing renal insufficiency, acute kidney injury, and those who had treatment with nephrotoxic agents, only 21 patients had had serum magnesium and K+ levels measured both before and after MgSO4 administration. Results: Among the 21 subjects, there was a significant increase in mean serum K+ concentration before and during MgSO4 infusion, from 4.1 ± 0.1 to 4.9 ± 0.1 mEq/L (P＜0.001). In addition, there was significant hypermagnesemia (6.5 ± 0.3 mg/dL) and hypocalcemia (6.7 ± 0.2 mng/dL) during treatment. Nine of the 21 patients had serum K+ concentrations exceeding 5.0 mEq/L (mean, 5.4 ± 0.2 mEq/L). A positive correlation was found between the increase in serum K+ concentration and the cumulative MgSO4 dose (r=0.66, P=0.027). Conclusion: Prolonged MgSO4 therapy in preeclampsia may result in a significant increase in serum concentration in a dose-response manner.
並列摘要
Background: Although magnesium sulfate (MgSO4) has been effectively employed to treat toxemia, hyperkalemia associated with its prolonged administration has not been well recognized. We reviewed retrospectively the records of women with preeclampsia who received prolonged MgSO4 administration to assess serum potassium (K+) levels. Methods: Over a 3-year period, 587 women with preeclampsia were treated with MgSO4. Excluding patients with pre-existing renal insufficiency, acute kidney injury, and those who had treatment with nephrotoxic agents, only 21 patients had had serum magnesium and K+ levels measured both before and after MgSO4 administration. Results: Among the 21 subjects, there was a significant increase in mean serum K+ concentration before and during MgSO4 infusion, from 4.1 ± 0.1 to 4.9 ± 0.1 mEq/L (P＜0.001). In addition, there was significant hypermagnesemia (6.5 ± 0.3 mg/dL) and hypocalcemia (6.7 ± 0.2 mng/dL) during treatment. Nine of the 21 patients had serum K+ concentrations exceeding 5.0 mEq/L (mean, 5.4 ± 0.2 mEq/L). A positive correlation was found between the increase in serum K+ concentration and the cumulative MgSO4 dose (r=0.66, P=0.027). Conclusion: Prolonged MgSO4 therapy in preeclampsia may result in a significant increase in serum concentration in a dose-response manner.