[Hypocalcemic delirium due to magnesium sulphate therapy in a pregnant woman with pre-eclampsia].
A 34-year-old pregnant patient, admitted with severe pre-eclampsia and the 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome at 31 weeks gestational age, was treated with magnesium sulphate for imminent eclampsia. The further management was aimed at prolonging gestation. During treatment, a delirium developed with myoclonus. As the foetal condition deteriorated, caesarean section was performed. Afterwards, the delirium proved to have been due to hypocalcaemia. After appropriate treatment the patient recovered. In pre-eclampsia, the calcium metabolism is disturbed. Hypermagnesaemia inhibits parathyroid hormone secretion and can therefore cause hypocalcaemia. In rare cases, this may cause a delirium, which is unusual in pre-eclampsia. If the clinical (neurological) picture in a pregnant woman with severe pre-eclampsia, who is receiving treatment with magnesium sulphate, is not fully understood, hypocalcaemia should be considered.
Ganzevoort
J W
JW
Afd. Verloskunde en Gynaecologie, Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam. j.w.ganzevoort@amc.uva.nl
Hoogerwaard
E M
EM
van der Post
J A M
JA
D000328:Adult; D002118:Calcium / Q000378:metabolism; D003693:Delirium / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D017359:HELLP Syndrome / Q000188:drug therapy*; D006801:Humans; D006996:Hypocalcemia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D008278:Magnesium Sulfate / Q000009:adverse effects* / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome
D008278:Magnesium Sulfate; D002118:Calcium