Magnesium Therapy in Preeclampsia

Dosage and Administration

The European Society of Cardiology recommends a loading dose of 4-6 g IV in 20-30 minutes to achieve immediate therapeutic levels, followed by a maintenance dose, with a strength of evidence based on comparative studies 1
The American Heart Association suggests that a maintenance dose of 2 g/hour IV is more effective than 1 g/hour in achieving therapeutic levels, especially in patients with a body mass index (BMI) ≥25 kg/m², with 70-80% of patients reaching therapeutic levels within 2-4 hours 2

The European Heart Journal advises against combining magnesium sulfate with nifedipine due to the risk of severe hypotension and myocardial depression, with a high strength of evidence 1
The American Heart Association recommends limiting fluid intake to 60-80 mL/hour to prevent pulmonary edema in preeclamptic patients with capillary leak, based on clinical guidelines 2

The International Society for the Study of Hypertension in Pregnancy indicates that magnesium sulfate should be administered to women with preeclampsia who present with severe hypertension (≥160/110 mmHg) and significant proteinuria (≥3+), with a moderate strength of evidence 2
The European Society of Cardiology recommends magnesium sulfate for patients with moderate hypertension (≥150/100 mmHg) and proteinuria ≥2+ with signs of imminent eclampsia, such as headache, visual disturbances, and clonus, based on clinical guidelines 1