Magnesium vs Diazepam

[dewald]

Hi; I'm looking for other opinions concerning Magnesium vs Diapepam for a patient that has seizures due to eclampsia; I know there is alot of articles that support magnesium first; I there anyone that had first hand experience with this please let me know ; my concern is how long will it take for magnesium to stop the seizures - Maybe i'm still old school but i still think that the primary goal is to terminate the seizure with diazepam and then to give the loading dose of magnesium. :?:

[croaker260]

Hi; I'm looking for other opinions concerning Magnesium vs Diapepam for a patient that has seizures due to eclampsia; I know there is alot of articles that support magnesium first; I there anyone that had first hand experience with this please let me know ; my concern is how long will it take for magnesium to stop the seizures - Maybe i'm still old school but i still think that the primary goal is to terminate the seizure with diazepam and then to give the loading dose of magnesium. :?:

The research, as well as personal converstations I have had with a very well respected local OB (who trained at Harborview and has a lot of Pro-EMS respect) clearly shows a preferece toward MAG FIRST followed by benzos if refractory.

If it is truely eclampsia it should respond promptly to mag.

Heres the catch.

She tells a very compelling story of a lady who had delivered less than 12 hours previous, with acutely altered LOC, and looking for all the world like progressing eclampsia. Ironically, oen thing felt off, and she ordered a stat CT, and she actually has a bleed from her HTN (she was Dx pre-eclamptic already). The point is dont discount the use of Benzos , and keep your options and mind open..but if it is truely Eclampsia, it will respond better to mag than benzos. If it doesnt, be quick with the benzos.

Our protocol for it:

http://www.adaweb.net/departments/paramedics/swo/ob04.pdf

ALS SPECIFIC CARE: See General OB Care Protocol OB-1

- Assess and identify causes of complaints, treat as needed.

SEIZURES AND SEVERELY ALTERED LOC

- Magnesium Sulfate

IV: 1-2 g every 5 minutes, repeat as needed up to 5 g. Take 2 g

(4cc), Dilute to 20 cc to make 10% solution. Do not give faster

than 1 g/minute.

Maintenance Infusion: 5 g/250 cc or 2 g/100cc buritrol, run at 100

cc/hr (2 g/hr)

- For refractory seizure activity see seizure protocol (M-6)

- Consider Magnesium Sulfate (as noted above) in cases where a patient has not

seized but is obviously and severely pre-eclamptic (medical control order).

[Ecnalubma08]

Make sure there's Calcium Gluconate on hand

[AZCEP]

You do not want to use calcium to counteract the effects of magnesium if you are using it for seizure control.

Ideally you would be able to use the magnesium prior to the onset of the seizure. If the patient is actively seizing, the BZD will have a better chance of breaking the seizure, but can also cause problems for the infant.

[dewald]

You do not want to use calcium to counteract the effects of magnesium if you are using it for seizure control.

Ideally you would be able to use the magnesium prior to the onset of the seizure. If the patient is actively seizing, the BZD will have a better chance of breaking the seizure, but can also cause problems for the infant.

Very valid point thank you Sir

[dewald]

Make sure there's Calcium Gluconate on hand

Calcium Gluconate is removed from our protocal, the only drugs we have for eclampsia is magnesium and the benzo's

[resqmdc14]

I would be a strong advocate for Mag if we could carry it here. Unfortuneately we only have Valium for seizures, regardless of the circumstances. I wouldn't mind researching this more myself so that I could try to put something together to present our State office to maybe convince them to look at a Mag protocol for us.

[Dustdevil]

I would be a strong advocate for Mag if we could carry it here.

Are you urban, suburban, or rural?

I can understand the reluctance to put mag into urban systems. But the situations that require mag are pretty serious situations, and there is no excuse for not having it available in a rural, long-transport system.

[croaker260]

Are you urban, suburban, or rural?

I can understand the reluctance to put mag into urban systems. But the situations that require mag are pretty serious situations, and there is no excuse for not having it available in a rural, long-transport system.

Considering the wide range of Mag uses (eclampsia, torsades, 2nd or 3rd line anti-dysrythmic, severe asthma) and its cost (CHEAP) IMHO there is no reason NOT to carry mag, urban or rural.

[Ridryder 911]

Treat the cause then the effect (if even needed).

R/r 911