Magnesium sulphate for treatment of tetanus in adults.
There are reports that suggest that magnesium sulphate alone may control muscle spasms thereby avoiding sedation and mechanical ventilation in tetanus, but this has not been confirmed. We examined the efficacy and safety of intravenous magnesium sulphate for control of rigidity and spasms in adults with tetanus. A prospective clinical study of intravenous magnesium sulphate was carried out over a period of two years in a tertiary care teaching hospital. In addition to human tetanus immunoglobulin and parenteral antibiotics, patients with tetanus received magnesium sulphate 70 mg/kg intravenously followed by infusion. The infusion was increased by 0.5 g/hour every six hours until cessation of spasms or abolishment of patellar tendon jerk. The primary outcome measure was efficacy determined by control of spasms. Secondary outcomes included frequency of autonomic instability, duration of ventilatory support, hospital stay and mortality. Thirty-three patients were enrolled. At presentation, the incidence of severity of tetanus was as follows: Grade I: 5 (15%), Grade II: 13 (39%), Grade III: 14 (42%) and Grade IV: 1 (3%). Rigidity and mild spasms were controlled with magnesium therapy alone in six patients; all were Grades I or II. Additional sedatives were required in severe forms of tetanus. The average duration of ventilatory support was 18.3 +/- 16.0 days and the overall mortality was 22.9%. Asymptomatic hypocalcaemia was a universal finding. Magnesium sulphate therapy alone may not be efficacious for the treatment of severe tetanus.
Mathew
P J
PJ
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Samra
T
T
Wig
J
J
D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy / Q000209:etiology; D015331:Cohort Studies; D003975:Diazepam / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007262:Infusions, Intravenous; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009127:Muscle Rigidity / Q000188:drug therapy / Q000209:etiology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial; D013035:Spasm / Q000188:drug therapy / Q000209:etiology; D013742:Tetanus / Q000188:drug therapy*; D013745:Tetanus Toxoid / Q000627:therapeutic use
D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D013745:Tetanus Toxoid; D008278:Magnesium Sulfate; D003975:Diazepam