If administered intramuscularly, abscess happened on 0.5% in case and followed by pain, based on that reason it is more preferred administered intravenously. For the intravenous route use INFUSAN MgSO4 20% while for intramuscular route use INFUSAN MgSO4 40%.
A. Severe Pre-eclampsia with more than 37 weeks pregnancy: Inject Magnesium Sulfate 8 g i.m (4 g for the left buttock and 4 g for the right buttock) followed by injection of 4 g Magnesium Sulfate each 4 hours.
Preferably continue giving Magnesium Sulfate until 24 hours post partum if not contraindicated. Could be stopped earlier whenever the blood pressure is becoming normal (normotensive) after 8 hours severe control.
B. Severe Pre-eclampsia with less than 37 weeks pregnancy: In case the fetus indicates lung maturity (Lecithin sphingomyelin ratio, shake test), treat according to A.
In case the fetus does not yet indicate lung maturity, inject Magnesium Sulfate during 24 hours (32 g), if it is not contraindicated. Catapres or diuretic could be given whenever indicated (Ref. A).
1. If no progress appears, terminate the pregnancy.
2. If progress appears: When mild pre-eclampsia is not yet reached, continue giving Magnesium Sulfate for 2 x 24 hours, whenever it is not contraindicated. Injection could begin with giving at once Magnesium Sulfate 4 g 20% intravenous solution slowly (5 -10 minutes), followed by Magnesium Sulfate 4 g intramuscularly every 4 hours. Further on if mild pre-eclampsia not yet appears, but clear progress observed, treat further and give Magnesium Sulfate 1 x 8 hours or 1 x 12 hours to avoid convulsion. Partus induction for 37 weeks pregnancy (viable for life) or the fetus indicated lung maturity.
Whenever mild pre-eclampsia is reached: stop giving Magnesium Sulfate, further treatment refer to the mild pre-eclampsia treatment but take care further. Monitoring and evaluation of the condition of the mother and fetus should be done further accurately.
Eclampsia: Begin by giving intravenously 20 mL of INFUSAN MgSO4 20% for 3 - 4 minutes, follow immediately 10 g i.m. (25 mL of INFUSAN MgSO4 40%), so the total loading dose is 14 g. If within 20 minutes still convulsions happen, add another 2 - 4 g intravenously. Rarely appears convulsions, slowly give amobarbital (until 250 mg) intravenously, further on give 5 g Magnesium Sulfate each 4 hours until 24 hours post partum.
In Brief: Treatment with Magnesium Sulfate intramuscularly is as follows: 4 g i.v. + 10 g i.m. as the loading dose (totally 14 g) can be added 2 - 4 g i.v.
Can be added 250 mg Sodium Amobarbital, followed by 5 g Magnesium Sulfate every 4 hours until 24 hours post partum.
Treatment with Magnesium Sulfate Intravenously is as follows: 4 - 6 g i.v. as the loading dose, followed by 1 g i.v. until 24 hours post partum.
By every time giving Magnesium Sulfate, every hour shall be checked whether the requirements are still conformed.