Eclampsia: Difference between revisions
| Line 19: | Line 19: | ||
#**Must adjust dose in patients with renal failure | #**Must adjust dose in patients with renal failure | ||
#*If seizures recur: | #*If seizures recur: | ||
#**Consider alternative diagnosis | |||
#**Consider other anticonvulsant drugs | #**Consider other anticonvulsant drugs | ||
#** | #***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]] | ||
#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>: | #*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>: | ||
#**Severe [[renal failure]] | #**Severe [[renal failure]] | ||
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#**Hydralazine | #**Hydralazine | ||
#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg | #***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg | ||
#*Persistent seizure | |||
#**See [[status epilepticus]] | |||
#**Plan appropriately for delivery | |||
==Disposition== | ==Disposition== | ||
Revision as of 02:18, 27 February 2019
Background
- Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
- May occur sooner with gestational trophoblastic disease
- Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures
Differential Diagnosis
Seizure
- Epileptic seizure
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with anti-epileptic medications
- Hyponatremia
- INH toxicity
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Brain abscess
- Intracranial hemorrhage
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Barbiturate withdrawal
- Baclofen withdrawal
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia, hepatic failure, uremia
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Acute hydrocephalus
- Arteriovenous malformation
- Seizure with VP shunt
- Toxic ingestion (amphetamines, anticholinergics, cocaine, INH, organophosphates, TCA, salicylates, lithium, phenothiazines, bupropion, camphor, clozapine, cyclosporine, fluoroquinolones, imipenem, lead, lidocaine, metronidazole, synthetic cannabinoids, theophylline, Starfruit)
- Psychogenic nonepileptic seizure (pseudoseizure)
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Management
- Delivery
- Seizure treatment
- Magnesium: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
- Can give up to 10 gm IM (5 g in each buttock)
- Observe for loss of reflexes, respiratory depression
- Must adjust dose in patients with renal failure
- If seizures recur:
- Consider alternative diagnosis
- Consider other anticonvulsant drugs
- Contraindications to magnesium[1]:
- Magnesium: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
- BP Control
- Lower to Sys 130-150, dia 80-100
- Labetalol
- Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
- Option 2: Initial 20mg; then IV infusion of 1-2mg/min
- Hydralazine
- 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
- Labetalol
- Persistent seizure
- See status epilepticus
- Plan appropriately for delivery
- Lower to Sys 130-150, dia 80-100
Disposition
- Emergent OB/GYN consultation
See Also
References
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate