Magnesium sulfate is used to help prevent eclamptic seizures and stroke. These are caused by brain swelling. Other symptoms of brain swelling include severe headache that does not respond to any treatment, visual disturbances that do not fade away, hyper reflexes, and clonus. If you have these symptoms, you want the mag! Mag is also often given without these symptoms if you have other severe symptoms that make doctors think brain swelling could start soon. The list of severe symptoms includes blood pressure with either number over 160/110, platelets under 100, liver enzymes more than twice the upper limit of normal, pulmonary edema (fluid in the lungs), or other signs of organ failure.Different doctors have different cut-offs. Some give it to all their preeclampsia patients during labor and post partum, even without severe symptoms. You can ask your doctor when they recommend mag and why. Note: Mag may also be recommended in other circumstances apart from preeclampsia. It is sometimes used to stop preterm labor, or to protect baby's brain during a very preterm delivery.)
I do not want seizures or stroke, so this all sounds great! But why does it have such a bad reputation?
Magnesium sulfate can have some unpleasant side effects. The most common one is feeling very hot. Turning down the temperature in your room, a fan, and cold packs can help with this. Mag is a smooth muscle relaxer. It can make you very weak. (The weakness plus the heat can feel like influenza, leading to the nickname Mag Flu.) You are a fall risk while on mag, which may mean you cannot get out of bed and have to use a catheter or bed pan. You may not be allowed to hold your baby without assistance, since you could drop him/her. If baby is in the NICU, you may not be able to visit right away if there is no staff available to help you. Mag relaxes the muscles of your eyes, leading to blurry vision. It relaxes the muscles of your digestive system, making you a choke risk. You may not be allowed food and drink, or may be limited in what you can eat or drink. Mag toxicity is a concern. They may do frequent blood tests to make sure the levels are not getting too high, and adjust your dose accordingly. But some of the bad effects that get blamed on mag are actually due to the brain swelling it is being used to treat. If you have visual, auditory, or tactile hallucinations? That is probably the brain swelling. Memory issues? Also probably the brain swelling. Confusion and sense of doom? Brain swelling.
I want to hold my baby right away, eat, and use the bathroom on my own. Can I refuse the mag to avoid these restrictions?
Yes, you have the right to refuse any test, treatment, or procedure for any reason. But should you refuse mag? Considering the very real risk of seizures, stroke, and death, we will never suggest you go against your doctor's recommendation on this. We will suggest you have a conversation with your doctor about exactly why it is recommended in your case. If you have signs of brain swelling or other severe symptoms, you should think very carefully whether the risk of seizures, stroke, and death is worth it. If you do not have severe symptoms but your doctor uses it for all preeclampsia patients as a precaution, you can discuss whether you could wait and watch for other symptoms first. It is hard to have to wait 24 hours to hold your baby. It is ok to be sad and grieve missing out on that time. But better that than missing out on a whole lifetime because you died or struggling to care for your child after a stroke.
Are there alternatives to magnesium sulfate? Could I take oral magnesium supplements instead?
Oral magnesium citrate or magnesium oxide supplements are completely different substances to magnesium sulfate. They will not help with seizures. Magnesium sulfate is the best option we have for treating or preventing eclamptic seizures. If you cannot use it for some reason, they can use other seizure medications, but they are not as effective. The underlying process of eclamptic seizures is different from, say, epileptic seizures. So while other medications may help to some extent, mag is still the best option and first choice for preeclampsia.
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