Case Report Posterior Reversible Encephalopathy Syndrome with Magnesium Toxicity
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 5
Abstract
PRES isclinic-radiological entitycharecterisedby Headache, Visual disturbance, Altered sensorium, Seizures and White mattervasogenicedema. PRES is associated with acute renal failure, hypertension, eclampsia, vascular and autoimmune disease, immunosuppressivedrugs and organ transplantation.Magnesium sulfateis drug of choice in eclampsia.Magnesium sulfate is given byintramuscular or intravascular route for prevention of and treatment ofeclampsia.Magnesium toxicity can be detected by signs and symptoms like loss of deep tendon reflexes, decreased respiratory rate(less than 12), decreased urine output(less than 30ml/hr), chest pain ,heart block, pulmonary edema, and respiratory distress.24 year old 2nd gravida postpartum female referred from peripherywith history of convulsions 4 hours after normal vaginal full term delivery. On admissionpatient was unconscious, noresponse to painful stimuli, absent deep tendon reflexes, absent plantar, pupils sluggishly reactive to light, and urine output was<100/24 hrs.History revealed that patient was given magnesium sulfatebefore and after deliveryas treatment of eclampsia.MRI brain showed asymmetrical altered signals in bilateral occipital cortical region in T2 and FLAIR suggestive of PRES.Patient is diagnose as PRES with septicaemia with acute kidney injury with magnesium toxicity. Patient improved after management with iv fluids, antibiotics,antiepileptics,hemodialysis, iv calcium gluconate andblood pressure monitoring.PRES can be major problem in pre-eclamsia, eclampsia with renal failure.Magnesiumsulfateshould not be given without monitoring signs and symptoms of magnesium toxicity.A high index of suspicion and prompt treatment can reduce morbidity and mortality.
Authors and Affiliations
Dr. Piyush Savaliya, Dr. Somesh Nagre, Dr. Vasim Mansuri, Dr. Amit Gamit, Dr. Soham Chaudhari
Keywords
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- EP ID EP373932
- DOI 10.9790/0853-1705020911.
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