title: Survival of a patient with tetanus in Bhutan using a magnesium infusion managed only by clinical signs.
abstract: Tetanus is a life-threatening disease that continues to have a high prevalence in developing countries. Severe muscle spasms often require patients to receive tracheostomy, high-dose sedatives, and sometimes prolonged neuromuscular blockade. Magnesium sulfate (MgSO4) infusion has great promise as an adjunct treatment for severe tetanus, as it may allow clinicians to decrease the dose of other sedative medications. Although the mechanism of action of MgSO4 is not well understood, it appears to attenuate both the muscle spasms and autonomic instability associated with severe tetanus infections. However, MgSO4 infusions are often managed based on serial measurements of serum magnesium levels and other laboratory tests such as arterial blood gases, which can be difficult to obtain in resource-poor settings. We describe a case of severe tetanus in Bhutan managed through the use of magnesium infusion titrated solely to physical examination findings.
authors.affiliation: Department of Anaesthesiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Kuenza P
authors.initials: KP
authors.lastname: Wangmo
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Margie
authors.initials: M
authors.lastname: Teng
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Richard
authors.initials: R
authors.lastname: Henker
authors.affiliation: Flinders Medical Centre, Bedford Park, South Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kinnear
authors.affiliation: Department of Anaesthesiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Jampel
authors.initials: J
authors.lastname: Tshering
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wang
mesh_terms: D001631:Bhutan; D006801:Humans; D007262:Infusions, Intravenous; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013742:Tetanus / Q000188:drug therapy*; D014139:Tracheostomy
chemical_list: D008278:Magnesium Sulfate
keywords: Bhutan; anticonvulsants; autonomic nervous system diseases; developing countries; magnesium sulfate; tetanus