![]() ![]() Strengthening the supply chain of these important medicines is paramount to ensuring their effectiveness in reducing maternal deaths in Nigeria. The prevalence of particularly of oxytocin and misoprostol commodities was of substandard quality. Magnesium sulfate and Calcium gluconate injection samples recorded a failure rate of 6.8% and 2.4%, respectively. Misoprostol tablets recorded a percentage failure of 33.7%. Approximately, 74.2% of oxytocin injection samples failed the assay test, with the northeast and southeast zones registering the highest failure rates. Samples of these commodities were procured mainly from wholesale and retail pharmacies, where these were readily available, while the federal medical centers reported low availability. Other tests included sterility, pH measurement, and fill volume. Titrimetric methods were used to analyze 164 samples of magnesium sulfate and 148 samples of calcium gluconate injection. Analysis for identification and content of active pharmaceutical ingredient was performed using high-performance liquid chromatography procedures of 159 samples of oxytocin injection and 166 samples of misoprostol tablets. Simple, stratified random sampling of health facilities in each of the political zones of Nigeria. ![]() In this study, the quality of oxytocin injection, misoprostol tablets, magnesium sulfate, and calcium gluconate injections was assessed across the six geopolitical zones of Nigeria. Most of those medicines are sensitive to environmental conditions and must be handled properly. Calcium gluconate must be in the room when magnesium sulfate is being administered as it is the antidote for magnesium toxicity. The impact of quality medicines in the management of these complications cannot be overemphasized. The case will end post intubation when the patient has been referred to OB.The high level of maternal mortality and morbidity as a result of complications due to childbirth is unacceptable. The patient will also remain hypertensive, requiring administration of an appropriate antihypertensive agent. Magnesium sulfate is the primary medication used in the prevention and management of eclamptic seizures and exerts its effect by depressing the central nervous system.1 In the setting of severe preeclampsia, magnesium sulfate has been shown to significantly reduce the rate of eclampsia compared to placebo, phenytoin, nimodipine, or diazepam. The patient will then require intubation for respiratory depression. She will not stop seizing until magnesium sulfate is given. As the team coordinates her initial workup, the patient will begin to seize. Case SummaryĪ 30 year-old female, G1P0 at 32 weeks, presents to the ED with headache, blurred vision, nausea, and vomiting. Now her vision feels blurred, so she came for assessment. This morning she started feeling nauseous and began vomiting. Miranda Hamm presents to your local tertiary care ED complaining of a headache. Recognition of apnea as a side effect of magnesium administration calcium gluconate is an antidote. ![]() Immediately d/c and admin calcium gluconate. 4.5 Interaction with other medicinal products and other forms of interaction. Signs of mag toxicity absence of patellar deep tendon relfexes, urine output less than 30 ml/hr, respirations less than 12/ min, decreased loc, cardiac dysrhythmias. An antidote of injectable calcium gluconate solution should be immediately available. Adding an anti-hypertensive agent if the blood pressure remains elevated after magnesium administration Magnesium Sulfate 10 w/v solution may be administered by intravenous or subcutaneous routes (see Method of administration below). ![]() Early administration of magnesium sulfate.This case highlights three important aspects of managing an eclamptic patient: Caners is a PGY4 Emergency Medicine resident and one of the editors-in-chief at EMSimCases. ![]()
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