Clin Pharmacokinet. 2000 Apr;38(4):305-14.

Magnesium sulfate in eclampsia and preeclampsia: pharmacokinetic principles.

L !"# $i%htin%ale C&. 'a%ne(i m ( l)at ( '%*+4 ) a,alah o-at .an% palin% m m ,i% nakan nt k

pen%o-atan eklamp(ia ,an pro)ilak(i( eklamp(ia pa,a pa(ien ,en%an preeklamp(ia -erat . &al ini -ia(an.a ,i-erikan melal i intram (k lar ata intra/ena . 0e%imen intram (k lar .an% palin% (erin% a,alah loa,in% ,o(i( intra/ena 4 %ram # (e%era ,iik ti oleh 10 % intram (k ler ,an kem ,ian 5 % intram (k ler (etiap 4 1am -okon% kanan -okon% kiri. 0e%imen intra/ena ,i-erikan (e-a%ai 4 % ,o(i(# ,iik ti ,en%an in) ( maintenance 1 (ampai 2 % 2 1am terkontrol . *etelah pen%% naan '%*+4 (ekitar 403 ,ari ma%ne(i m pla(ma terikat protein. 4on ma%ne(i m .an% ti,ak terikat -er,i) (i ke ,alam r an% ek(tra/a(k ler - ek(tra(el ler# ke ,alam t lan%# ,an melal i pla(enta ,an (elap t 1anin ,an ke 1anin ,an cairan ket -an . Pa,a i- hamil# /ol me ,i(tri- (i ion -ia(an.a mencapai nilai kon(tan antara 1am keti%a ,an keempat (etelah pem-erian # ,an ki(aran 0#250-0#442 L 2 k% . 'a%ne(i m hampir (ecara kh ( ( ,iek(kre(ikan ,alam rin# ,en%an 503 ,ari ,o(i( ,iek(kre(ikan (elama 24 1am pertama (etelah in) ( intra/ena '%*+4. Pro)il )armakokinetik '%*+4 (etelah pem-erian intra/ena ,apat ,i1ela(kan oleh mo,el 2 kompartemen ,en%an ,i(tri- (i cepat ( a) )a(e # ,iik ti oleh )a(e lam-at elimina(i -eta relati). 6)ek klini( ,an tok(i(ita( '%*+4 ,apat ,ih - n%kan ,en%an kon(entra(i ,alam pla(ma. 7on(entra(i '%*+4 (e-an.ak 1#8-3#0 mmol 2 L telah ,i(arankan nt k pen%o-atan ke1an% eklamp(ia . 8o(i( ma%ne(i m .an% (e-enarn.a ,an kon(entra(i .an% ,i- t hkan nt k pro)ilak(i( -el m pernah ,iperkirakan . 9ok(i(ita( ikarena '%*+4 1aran% ter1a,i ketika '%*+4 ,ikelola ,an ,en%an hati-hati. 9an,a tok(i(ita( pa,a i- a,alah hilan%n.a r(e)lek( patela pa,a kon(entra(i pla(ma antara 3#5 ,an 5 mmol 2 L. 7el mp han pernapa(an ter1a,i pa,a 5-:#5 mmol 2 L. 7on, k(i 1ant n% -er -ah pa,a kon(entra(i le-ih ,ari ;#5 mmol 2 L # ,an (eran%an 1ant n% ,apat ter1a,i ketika kon(entra(i ma%ne(i m mele-ihi 12#5 mmol 2 L. 'a%ne(i m ( l)at men% ran%i kontrak(i otot l rik ,an -lok tran(mi(i ne rom (k ler peri)er ,en%an men% ran%i pelepa(an a(etilkolin melepa(kan ,i myoneural junction. 8alam

pera<atan ,ar rat # ma%ne(i m ( l)at ,i% nakan nt k men%elola ke1an% .an% -erh - n%an ,en%an tok(emia %ra/i,ar m. 7e% naan lain melip ti relak(a(i rahim ( nt k men%ham-at kontrak(i per(alinan premat r) # (e-a%ai -ronko,ilator -eta - a%oni( ,an antikoliner%ik# pen%%antian terapi kek ran%an ma%ne(i m# (e-a%ai katar(i( nt k men% ran%i pen.erapan rac n ,ari (al ran =l# ,an ,alam terapi a<al nt k ke1an%. 'a%ne(i m ,apat ,i% nakan (e-a%ai pen%o-atan ,i(ritmia # kh ( (n.a tor(a,e( ,e pointe( # ,an ,i(ritmia (ek n,er nt k (e- ah o/er,o(i( anti,epre(an tri(iklik ata tok(i(ita( ,i%itali(. +-at ini 1 %a ,ian%%ap (e-a%ai a%en 4la kela( (m n%kin mem-ant ) nt k re)raktori )i-rila(i /entrikel ,an takikar,i /entrikel (etelah pem-erian ,o(i( li,okain ata -ret.li m .

Deskripsi *e- ah ( plemen %i>i intra/ena anak. *e,iaan - Amp l - "liptop ?ial *ol (in.a ti,ak men%an, n% -acterio(tat# a%en antimikro-a ata ,i- an% ,alam <akt 24 1am pen%% naan a<al. - ))er tam-ah (kec ali nt k mence%ah ata men%o-ati h.poma%ne(emia ,an

(arana nt k kontrol parenteral ke1an% pa,a tok(emia %ra/i,ar m ,an ne)riti( ak t pa,a anak-

nt k pen%at ran p&). *etiap -a%ian .an% ti,ak terpakai .an% ter(i(a ,alam <a,ah har (

Lar tann.a ti,ak men%an, n% -aketeri# a%en antimikro-a ata ,alam <akt 24 1am pen%% naan a<al.

- ))er (kec ali

nt k

pen%at ran p&). *etiap -a%ian .an% ti,ak terpakai .an% ter(i(a ,alam <a,ah har ( ,i- an% 'a%ne(i m * l)at# @*P heptah.,rate (ecara kimia<i ,alam (tr kt r '%*+4 A ;&2+# kri(tal -er<arna ata - - k p tih -e-a( lar t ,alam air.

Farmakologi
'a%ne(i m ( '% B B ) mer pakan ko)aktor pentin% nt k reak(i en>imatik ,an memainkan peran pentin% ,alam tran(mi(i ne rokimia ,an ran%(an%an otot . *e-a%ai tam-ahan %i>i hiperalimenta(i # mekani(me .an% tepat tin,akan nt k ma%ne(i m ti,ak pa(ti . =e1ala a<al h.poma%ne(emia ( k ran% ,ari 1#5 m6C 2 liter ) ,apat -erkem-an% (e,ini 3-4 hari ata -e-erapa min%% . 6)ek kek ran%an .an% tama a,alah ne rolo%i( # mi(aln.a # irita-ilita( otot # tonik klonik ,an tremor . &ipokal(emia ,an hipokalemia (erin% men%ik ti tin%kat (er m ren,ah ma%ne(i m . 'e(kip n a,a toko -e(ar ma%ne(i m ha,ir intra(el ler ,an t lan% oran% ,e<a(a # toko-toko ini (erin%kali ti,ak ,imo-ili(a(i c k p nt k mempertahankan tin%kat pla(ma . Parenteral ma%ne(i m per-aikan terapi ,e)i(it pla(ma ,an men.e-a-kan %e1ala ,e)i(ien(i ,an tan,a-tan,a nt k -erhenti . 'a%ne(i m mence%ah ata men%en,alikan ke1an% ,en%an mem-lokir tran(mi(i ne rom (k lar ,an men% ran%i 1 mlah a(etilkolin ,i-e-a(kan pa,a pelat 1 n% oleh imp l( (ara) motorik . 'a%ne(i m ,ikatakan memiliki e)ek ,epre(an pa,a (i(tem (ara) p (at # tetapi ti,ak mempen%ar hi i- # 1anin ata neonat ( -ila ,i% nakan (e( ai pet n1 k ,i eklamp(ia ata pre - eklamp(ia . 7a,ar ma%ne(i m pla(ma .an% normal -erki(ar 1#5-2#5 ata 3#0 m6C 2 liter . *e-a%ai ma%ne(i m pla(ma naik ,i ata( 4 m6C 2 liter# re)lek( ten,on ,alam .an% pertama men r n ,an kem ,ian men%hilan% (e-a%ai tin%kat pla(ma men,ekati 10 m6C 2 liter . Pa,a tin%kat ini# parali(i( pernapa(an m n%kin ter1a,i. Dlok 1ant n% 1 %a ,apat ter1a,i pa,a ini ata men r nkan ka,ar pla(ma ma%ne(i m.'a%ne(i m -ertin,ak peri)er nt k men%ha(ilkan /a(o,ilata(i. 8o(i( .an% le-ih -e(ar men.e-a-kan pen r nan tekanan ,arah. 6)ek kerac nan ma%ne(i m ,apat ,iata(i ,en%an pem-erian anto%oni( ma%ne(i m ,en%an men%in1ek(i intra/ena kal(i m. *etelah pem-erian intra/ena e)ek antikon/ l(an (e%era ter1a,i ,an -erlan%( n% (ekitar 30 menit . *etelah pem-erian intram (k lar tim- ln.a ak(i ter1a,i pa,a (ekitar (at 1am ,an -erlan%( n% (elama ti%a (ampai empat 1am. *er m antikon/ l(an .an% e)ekti) -erki(ar ,ari

2#5 ata

3#0-;#5 m6C 2 liter . 'a%ne(i m ,iek(kre(ikan oleh %in1al han.a pa,a tin%kat

(e-an,in% ,en%an pla(ma kon(entra(i ,an )iltra(i %lomer l (.

Indikasi dan Penggunaan

'a%ne(i m * l)at 4n1ek(i# @*P cocok nt k terapi pen%%anti kek ran%an ma%ne(i m#
BB

ter tama ,i h.poma%ne(emia ak t ,i(ertai ,en%an tan,a-tan,a tetani (er pa ,en%an .an% ,iamati ,alam hipokal(emia. 8alam ka( ( ter(e- t# le/el (er m ma%ne(i m ('% ) -ia(an.a ,i -a<ah -ata( -a<ah normal (1#5 (ampai 2#5 ata 3#0 m6C 2 liter) ,an kal(i m (er m (Ca B B) tin%kat normal (4#3 (ampai5.3 m6C 2 liter) ata ,itin%%ikan. 'a%ne(i m ( l)at ,apat ,itam-ahkan ke camp ran n tri(i nt k memper-aiki ata mence%ah h.poma%ne(emia .an% ,apat tim- l (elama terapi. 'a%ne(i m * l)at 4n1ek(i# @*P 1 %a ,iin,ika(ikan (e-a%ai antikon/ l(an parenteral nt k pence%ahan ,an pen%en,alian ke1an% (kon/ l(i) ,alam toEemia %ra/i,ar m. 7etika ,i% nakan (ecara e)ekti) ,apat mence%ah ,an men%ontrol ke1an%-ke1an% eklamp(ia tanpa men.e-a-kan ,epre(i ,ari (i(tem (ara) p (at ,ari i- ata -a.i. 'a%ne(i m * l)at 4n1ek(i# @*P ,apat ,i% nakan nt k men%ontrol hiperten(i# en(e)alopati ,an ke1an%-ke1an% .an% -erh - n%an ,en%an ne)riti( ak t pa,a anak-anak. 7ontrain,ika(i 'a%ne(i m intra/ena ti,ak -oleh ,i-erikan kepa,a i- ,en%an tok(emia %ra/i,ar m (elama , a 1am (e-el m part (. 4?"8 pa,a pa(ien eklamp(ia har ( ,i(e,iakan nt k kontrol lan%( n% ,ari ke1an% .an% men%ancam 1i<a. Pen%% naan parenteral ,en%an a,an.a in( )i(ien(i %in1al ,apat men.e-a-kan kerac nan ma%ne(i m. P604$=A9A$: Pro, k ini men%an, n% al mini m .an% m n%kin -erac n. Al mini m ,apat mencapai tin%kat -erac n ,en%an pem-erian parenteral -erkepan1an%an 1ika ) n%(i %in1al ter%an%% . -a.i premat r (an%at -ere(iko karena %in1al mereka -el m matan%# ,an mereka memerl kan (e1 mlah -e(ar kal(i m ,an )o()at# .an% men%an, n% al mini m. Penelitian men n1 kkan -ah<a pa(ien ,en%an ker (akan ) n%(i %in1al# terma( k -a.i premat r# .an% menerima tin%kat parenteral al mini m pa,a le-ih ,ari 4 (ampai 5 mc% 2 k% 2 hari men.e-a-kan men mp kn.a al mini m pa,a tin%kat .an% -erh - n%an ,en%an (i(tem (ara) p (at ,an tok(i(ita( t lan%.

WASPADA
7arena ma%ne(i m ,ikel arkan ,ari t - h han.a oleh %in1al # o-at har ( ,i% nakan ,en%an hati-hati pa,a pa(ien ,en%an %an%% an %in1al . + tp t rine har ( ,ipertahankan pa,a tin%kat 100 mL (etiap empat 1am . Pemanta an ka,ar (er m ma%ne(i m ,an (tat ( klini( pa(ien a,alah pentin% nt k men%hin,ari kon(ek en(i o/er,o(i( ,an tok(emia . 4n,ika(i klini( ,ari re1imen ,o(i( .an% aman terma( k a,an.a re)lek( patela ,an ti,ak a,an.a ,epre(i pernapa(an ( napa( (ekitar 1: ata le-ih 2 menit ) . 7a,ar (er m ma%ne(i m -ia(an.a c k p nt k men%en,alikan ke1an% -erki(ar 3-: m%2100 ml ( 2#5-5#0 m6C 2 liter ) . 7ek atan re)lek( ten,on ,alam m lai men%ecil ketika tin%kat ma%ne(i m mele-ihi 4 m6C 2 liter . 0e)lek( m n%kin ti,ak a,a pa,a ka,ar (er m ma%ne(i m 10 m6C2 liter# ,i mana ter1a,i kel mp han pernapa(an. =aram kal(i m ( ntik har ( (e%era ter(e,ia nt k mela<an poten(i -aha.a kerac nan ma%ne(i m ,alam eklamp(ia. 'a%ne(i m * l)at 50 3 4n1ek(i # @*P har ( ,iencerkan ,en%an kon(entra(i 20 3 ata k ran% (e-el m 4?"8. '%*+ 4 ,iin1ek(ikan ,en%an lam-at ,an hati-hati# nt k men%hin,ari h.perma%ne(emia . lar tan 50 3 1 %a har ( ter,il (i men1a,i 20 3 ata k ran% nt k in1ek(i intram (k lar pa,a -a.i ,an anak-anak 'a%ne(i m * l)at terma( k ,alam 7ate%or 7ehamilan 4 A. *t ,i pa,a <anita hamil -el m men n1 kkan -ah<a in1ek(i ma%ne(i m ( l)at menin%katkan ri(iko kelainan 1anin 1ika ,i-erikan (elama (em a trime(ter kehamilan. !ika o-at ini ,i% nakan (elama kehamilan# kem n%kinan ker (akan 1anin m nc l ti,ak a,a. $am n# karena penelitian ti,ak ,apat men%e(ampin%kan kem n%kinan ker (akan# in1ek(i ma%ne(i m ( l)at har ( ,i% nakan (elama kehamilan han.a 1ika 1ela( ,iperl kan. 7etika ,ikelola oleh in) ( intra/ena (ecara kontin (ter tama nt k le-ih ,ari 24 1am (e-el m part () nt k men%en,alikan ke1an% pa,a i- toEemic# -a.i .an% -ar lahir m n%kin men n1 kkan tan,a-tan,a tok(i(ita( ma%ne(i m# terma( k ,epre(i ne rom (k ler ata pernapa(an. 6)ek *ampin% 6)ek (ampin% ma%ne(i m ,i-erikan parenteral -ia(an.a ,i(e-a-kan oleh kerac nan ma%ne(i m. =e1alan.a -er pa kemerahan# -erkerin%at# hipoten(i# re)lek( patella .an% men%hilan%# flaccid paralysis# hipotermia# kolap( (irk la(i# ,epre(i (i(tem (ara) p (at 1ant n% ,an kel mp han pernapa(an. +/er,o(i( ma%ne(i m ,imani)e(ta(ikan ,en%an pen r nan

ta1am tekanan ,arah ,an kel mp han pernapa(a . &ilan%n.a re)lek( patela a,alah tan,a klini( .an% -er% na nt k men,etek(i ter1a,in.a intok(ika(i ma%ne(i m. 8alam hal o/er,o(i(# /entila(i - atan har ( ,i(e,iakan (ampai %aram kal(i m ,apat ,i( ntikkan intra/ena nt k mela<an e)ek ma%ne(i m . Pa,a oran% ,e<a(a intra/ena 5 (ampai 10 m6C 10 3 kal(i m %l konat -ia(an.a akan memper-aiki kea,aan ,epre(i perna)a(an ata -lok 1ant n% aki-at kerac nan ma%ne(i m. 8alam ka( ( ek(trim# hemo,iali(i( m n%kin ,iperl kan &.perma%ne(emia pa,a -a.i -ar lahir m n%kin memerl kan re( (ita(i ,an /entila(i ,i-ant melal i int -a(i en,otrakeal ata /entila(i tekanan po(iti) intermiten (erta kal(i m intra/ena . Dosis dan Administrasi 8apat ,i-erika (ecara intra/ena ,an intram (k lar. Pem-erian intram (k ler '%*+4 m rni 50 3 mem-erikan ha(il terape tik ter-aik ,alam ka,ar pla(ma (etelah :0 menit# (e,an%kan ,o(i( 4? akan mem-erikan e)ek terapi (e%era. 7a,ar in1ek(i m mn.a ti,ak -oleh mele-ihi 1#5 mL kon(entra(i 10 3 ( ata ek i/alen) per menit # kec ali ,alam eklamp(ia -erat ,en%an ke1an% ( lihat ,i -a<ah ). Lar tan nt k in) ( intra/ena har ( ,iencerkan ,en%an kon(entra(i 20 3 ata k ran% (e-el m pem-erian . Pen%encer m m ,i% nakan a,alah 8eEtro(e 5 3 ,an $atri m 7lori,a 0#5 3. 8alam intram (k lar in1ek(i m rni ( 50 3 ) a,alah (ol (i .an% tepat nt k oran% ,e<a(a# tetapi (ol (in.a har ( ,iencerkan (ampai kon(entra(i 20 3 (e-el m (eperti in1ek(i pa,a anak-anak. Defisiensi Magnesium Pa,a pen%o-atan ,e)i(ien(i ma%ne(i m rin%an# ,o(i( la>im .an% ,i% nakan nt k ,e<a(a a,alah 1 % ata (etara ,en%an 8#12 m6C ma%ne(i m ( 2 mL lar tan 50 3 ) ,i( ntikkan intram (k ler (etiap enam 1am (e-an.ak empat ,o(i( ((etara ,en%an total 32#5 m6C ma%ne(i m per 24 1am ) . @nt k h.poma%ne(emia -erat# (e-an.ak 2 m6C ( 0#5 mL lar tan 50 3 ) per k% -erat -a,an ,apat ,i-erikan intram (k ler ,alam 1an%ka <akt empat 1am 1ika ,iperl kan . Ata # 5 % # ( (ekitar 40 m6C ) ,apat ,itam-ahkan ke (at liter 8eEtro(e 5 3 ata $atri m 7lori,a 0#5 3# in) ( intra/ena lam-at (elama ti%a 1am. 8o(i( maintenance .an% ,ian1 rkan nt k oran% ,e<a(a a,alah 5 (ampai 8 m6C ma%ne(i m 2 liter lar tan 9P$ # a( pan harian oran% ,e<a(a .an% kha( -erki(ar ,ari 10 (ampai 24 m6C.

Dalam Eklampsia Pa,a pre-eklamp(ia ata eklamp(ia -erat# total ,o(i( a<al ma%ne(i m ( l)at a,alah 10 (ampai 14 % (ecara intra/ena# ,o(i( 4 (ampai 5 % ,alam 250 mL ,ari 5 % Dextrose Injection. Pilihan .an% lain ,o(i( intram (k lar hin%%a 10 % ( 10 mL lar tan m rni 50 3 ,i (etiap pantat ) ata ,o(i( intra/ena a<al (e-an.ak 4 % ,apat ,i-erikan ,en%an men%encerkan lar tan 50 3 men1a,i lar tan ,en%an kon(entra(i 10 ata 20 3 # cairan encer ( 40 mL lar tan 10 3 ata 20 mL lar tan 20 3 ) kem ,ian ,apat ,i( ntikkan intra/ena (elama 3-4 menit . *elan1 tn.a # 4 (ampai 5 % ( 8 (ampai 10 mL lar tan 50 3 ) .an% ,i( ntikkan (ecara intram (k ler ke pantat kanan ata kiri -er%antian (etiap empat 1am# ter%ant n% pa,a re)lek( patella ,an ) n%(i perna)a(an mema,ai. 9in%kat (er m ma%ne(i m : m%2100 mL ,ian%%ap optimal ,an men% ran%i pen%% naann.a pa,a pa(ien an ria. nt k men%ontrol ke1an%. 9otal ,o(i( harian (24 1am) (ekitar 30 % (ampai 40 % ti,ak -oleh terle<ati

Adverse eactions
9he a,/er(e e))ect( o) parenterall. a,mini(tere, ma%ne(i m ( all. are the re( lt o) ma%ne(i m intoEication. 9he(e incl ,e )l (hin%# (<eatin%# h.poten(ion# ,epre((e, re)leEe(# )lacci, paral.(i(# h.pothermia# circ lator. collap(e# car,iac an, central ner/o ( (.(tem ,epre((ion procee,in% to re(pirator. paral.(i(. &.pocalcemia <ith (i%n( o) tetan. (econ,ar. to ma%ne(i m ( l)ate therap. )or eclamp(ia ha( -een reporte,.

!verdosage

'a%ne(i m intoEication i( mani)e(te, -. a (harp ,rop in -loo, pre(( re an, re(pirator. paral.(i(. 8i(appearance o) the patellar re)leE i( a (e) l clinical (i%n to ,etect the on(et o) ma%ne(i m intoEication. 4n the e/ent o) o/er,o(a%e arti)icial /entilation m (t -e pro/i,e, ntil a calci m (alt can -e in1ecte, intra/eno (l. to anta%oni>e the e))ect( o) ma%ne(i m. 4n a, lt( intra/eno ( a,mini(tration o) 5 to 10 m6C o) 103 calci m %l conate <ill ( all. re/er(e re(pirator. ,epre((ion or heart -lock , e to ma%ne(i m intoEication. 4n eEtreme ca(e(# peritoneal or hemo,ial.(i( ma. -e reC ire,. &.perma%ne(emia in the ne<-orn ma. reC ire re( (citation an, a((i(te, /entilation /ia en,otracheal int -ation or intermittent po(iti/e pre(( re /entilation a( <ell a( intra/eno ( calci m.

Dosage and Administration

Doth intra/eno ( an, intram (c lar a,mini(tration are appropriate. 4ntram (c lar a,mini(tration o) the n,il te, 503 (ol tion re( lt( in therape tic pla(ma le/el( in :0 min te(# <herea( 4.?. ,o(e( <ill pro/i,e a therape tic le/el almo(t imme,iatel.. 9he rate o) 4.?. in1ection (ho l, %enerall. not eEcee, 1.5 mL o) a 103 concentration (or it( eC i/alent) per min te# eEcept in (e/ere eclamp(ia <ith (ei> re( ((ee -elo<). *ol tion( )or intra/eno ( in) (ion m (t -e ,il te, to a concentration o) 203 or le(( prior to a,mini(tration. 9he ,il ent( commonl. (e, are 53 8eEtro(e 4n1ection# @*P an, 0.53 *o,i m Chlori,e 4n1ection# @*P. 8eep intram (c lar in1ection o) the n,il te, (503) (ol tion i( appropriate )or a, lt(# - t the (ol tion (ho l, -e ,il te, to a 203 concentration prior to ( ch in1ection in chil,ren. 4n 'a%ne(i m 8e)icienc. 4n the treatment o) mil, ma%ne(i m ,e)icienc.# the ( al a, lt ,o(e i( 1 %# eC i/alent to 8.12 m6C o) ma%ne(i m (2 mL o) the 503 (ol tion) in1ecte, intram (c larl. e/er. (iE ho r( )or )o r ,o(e( (eC i/alent to a total o) 32.5 m6C o) ma%ne(i m per 24 ho r(). "or (e/ere h.poma%ne(emia# a( m ch a( 2 m6C (0.5 mL o) the 503 (ol tion) per k% o) -o,. <ei%ht ma. -e %i/en intram (c larl. <ithin a perio, o) )o r ho r( i) nece((ar.. Alternati/el.# 5 %# (approEimatel. 40 m6C) can -e a,,e, to one liter o) 53 8eEtro(e 4n1ection# @*P or 0.53 *o,i m Chlori,e 4n1ection# @*P )or (lo< intra/eno ( in) (ion o/er a three-ho r perio,. 4n &.peralimentation 4n total parenteral n trition# maintenance reC irement( )or ma%ne(i m are not preci(el. kno<n. 9he maintenance ,o(e recommen,e, )or a, lt( i( 5 to 8 m6C ma%ne(i m2liter o) 9P$ (ol tion; t.pical ,ail. a, lt intake ran%e( )rom 10 to 24 m6C. "or in)ant(# the recommen,e, intake ran%e( )rom 0.25 to 0.: m6C2k%2,a.. 4n 6clamp(ia 4n (e/ere pre-eclamp(ia or eclamp(ia# the total initial ,o(e i( 10 to 14 % o) ma%ne(i m ( l)ate. 4ntra/eno (l.# a ,o(e o) 4 to 5 % in 250 mL o) 53 8eEtro(e 4n1ection# @*P or 0.53 *o,i m Chlori,e 4n1ection# @*P ma. -e in) (e,. *im ltaneo (l.# intram (c lar ,o(e( o) p to 10 %

(10 mL o) the n,il te, 503 (ol tion in each - ttock) are %i/en. Alternati/el.# the initial intra/eno ( ,o(e o) 4 % ma. -e %i/en -. ,il tin% the 503 (ol tion to a 10 or 203 concentration; the ,il te, )l i, (40 mL o) a 103 (ol tion or 20 mL o) a 203 (ol tion) ma. then -e in1ecte, intra/eno (l. o/er a perio, o) three to )o r min te(. * -(eC entl.# 4 to 5 % (8 to 10 mL o) the 503 (ol tion) are in1ecte, intram (c larl. into alternate - ttock( e/er. )o r ho r(# ,epen,in% on the contin in% pre(ence o) the patellar re)leE an, a,eC ate re(pirator. ) nction. 9herap. (ho l, contin e ntil paroE.(m( cea(e. A (er m ma%ne(i m le/el o) : m%2100 mL i( con(i,ere, optimal )or control o) (ei> re(. A total ,ail. (24 hr) ,o(e o) 30 to 40 % (ho l, not -e eEcee,e, an, le(( (ho l, -e (e, i) the patient i( an ric. 4n $ephritic *ei> re( 4n chil,ren <ith nephritic (ei> re(# the 503 concentration (ho l, -e ,il te, to a 203 (ol tion )or intram (c lar in1ection. 9he ,o(e )or chil,ren i( 20 to 40 m% (0.1 to 0.2 mL o) a 203 (ol tion) per k% o) -o,. <ei%ht a,mini(tere, intram (c larl. a( nee,e, to control (ei> re(. Parenteral ,r % pro, ct( (ho l, -e in(pecte, /i( all. )or partic late matter an, ,i(coloration prior to a,mini(tration# <hene/er (ol tion an, container permit. 8o not a,mini(ter nle(( (ol tion i( clear an, container i( n,ama%e,. 8i(car, n (e, portion. 9o pre/ent nee,le-(tick in1 rie(# nee,le( (ho l, not -e recappe,# p rpo(el. -ent# or -roken -. han,.

"o# Supplied
'a%ne(i m * l)ate 4n1ection# @*P i( ( pplie, in (in%le-,o(e container( a( )ollo<(: Li(t $o. 40;5 21:8 21:8 Container Amp le "liptop ?ial "liptop /ial 9otal Amo nt 1 %22 mL 5 %210 mL 10 %220 mL Concentration 503 503 503 m6C '%BB2mL 4 m6C2mL 4 m6C2mL 4 m6C2mL

*tore at 20 to 25FC (:8 to ;;F"). G*ee @*P Controlle, 0oom 9emperat re.H

MgSO4 Regimens for Women with Eclampsia: Mesage from the Collaborative Eclampsia Trial.
Suraiya egum 1# Sye! Ersha! "li 2

'%*+4 memiliki e)ek men%in, k(i /a(o,ilata(i (ere-ral ,an men1a,i anta%oni( nt k re(eptor ek(itatori %l tamat $-meth.l-8 a(partat .an% -erman)aat ,alam eklamp(ia. '%*+4 menin%katkan pro, k(i /a(o,ilator pro(ta(iklin en,otel# men%ham-at akti/a(i platelet ,an melin, n%i (el en,otel ,ari ce,era .an% ,ime,ia(i oleh ra,ikal -e-a(. A,a 1 %a - kti -ah<a ma%ne(i m mele-arkan arteri rahim man (ia. Pen%% naan '%*+4 ti,ak terkait ,en%an e)ek mer %ikan ,ari neonat (. D kti ter-ar 1 %a telah men.arankan -ah<a ,alam ek(po( r rahim ,en%an ma%ne(i m ,ikaitkan ,en%an pen r nan pre/alen(i cere-ral pal(. pa,a -a.i -o-ot lahir k ran% ,ari 1500 %ram.