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Magnesium-sulfate Osmotic demyelination syndrome secondary to hypermagnesaemia during pregnancy: case report

A 36-year-old woman developed osmotic demyelination syndrome (ODS) secondary to hypermagnesaemia during treatment with magnesium-sulfate for threatened premature labour. The primipara woman was hospitalised at 26 week and 6 day of gestation due to threatened preterm labour. She received parenteral ritodrine [ritodrine hydrochloride] for tocolysis. However, after 21 days, she exhibited an increase in the liver enzymes [aetiology unknown]. Therefore, ritodrine was gradually decreased, and she started receiving IV magnesium sulfate 1 g/h, following a loading dose of 4g. On day 5 of magnesium sulfate administration, she complained ptosis, lower limb muscle weakness and dizziness. On day 10, she was unable to walk in the usual way. These symptoms were considered secondary to hypermagnesaemia. Despite this, magnesium sulfate administration rate was increased for tocolysis. The serum magnesium concentration reached the maximum concentration of 5.1 mg/dL 12 days after initiation of magnesium sulfate. On day 16 of magnesium sulfate administration, i.e. week 32+1 of gestation, magnesium sulfate was stopped due to dyspnoea. Then, the woman underwent emergency caesarean delivery under unspecified anaesthetics. She delivered normal babies. Thereafter, despite discontinuation of magnesium sulfate, she was still unable to walk in the usual way. Serum magnesium concentration decreased by 1.7 mg/dL, 2 days following discontinuation of magnesium sulfate. On postoperative day 5, the anesthesiologist confirmed that she had spastic gait and upper-limb ataxia. Examination demonstrated hyperactivation of her deep tendon reflexes in both the upper and the lower limbs. Brain MRI confirmed the diagnosis of ODS. Afterward, she started rehabilitation and was discharged on postoperative day 17 walking independently. Takeshita Y, et al. A case of osmotic demyelination syndrome detected after cesarean delivery with the administration of magnesium sulfate for threatened preterm labor. JA 803504384 Clinical Reports 6: 68, No. 1, Dec 2020. Available from: URL: http://doi.org/10.1186/s40981-020-00376-x

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Reactions 3 Oct 2020 No. 1824