Last Day in the Hospital for a while?

Mindy has been switched from Mag Sulfate (4 gm loading, then 3 gm, then 2 gm, then 1 gm) to Procardia 10 mg tid (three times daily) . I forget that some of our audience are not all pharmacists and I found a good explanation of the rationale . . .the catheter is out, the antibiotics are in, she's using the bathroom instead of the bedpan and will be getting real clothes soon. She's basically a bedrest mom to be on oral meds.

They seem so pink and innocuous.

1. Why is magnesium sulfate used in treating preterm labor?
When a woman experiences preterm labor (defined as contractions and cervical effacement or dilation before term), sometimes she is given magnesium sulfate, which is thought to relax the muscles of the uterus. It is not FDA approved for treating preterm labor and is used "off label" for this purpose. It was introduced in the United States as a preterm labor drug in 1969, on the basis of laboratory work. (Lancet, 1997, Vol. 350, p. 1517)

One of the babies had to be pushed back in and we were definitely a close call with them coming out too soon. 

2. How is it administered?
It usually is given to patients through an IV in the hospital, dosages of magnesium that Mindy received were a loading (big) dose of 4 grams and she then received a continuous dose of 3, then 2 then 1 grams per hour.  

3. How long do patients take magnesium sulfate?
In preterm labor, magnesium sulfate is given over 24 or 48 hours to try to halt contractions, now Mindy is being put on a preterm labor drug nifedipine (Procardia) 10 mg tid and can be sent home if she continues to experience no contractions.

4. What are the side effects of magnesium sulfate?
The line between a "therapeutic" and "toxic" dose of magnesium sulfate is very thin. In general, the larger the dose, the greater the chance of severe side effects. Doctors can test your blood to see how much magnesium is in it, Mindy's Mag level got to 7.8 where 7 is the higher end of therapeutic and that's why she felt like death. Reflexes were reduced and the doctor shut it down.

More common side effects

Flushing - especially in the face, goes away almost immediately upon d/c ing the med

Flushing was awful...

 Nausea - Mindy had two very forceful vomiting episodes, one at midnight and another in the morning

• Palpitations - she didn't have palpitations, rather she had shakes, like someone who is shivering
  
• Headache - n/a
  
• General muscle weakness - she couldn't even get her eyelids up and they were turning purple
  
• Lethargy - zombies had more pep than she did after the mag
  
• Constipation - she's just back from her third trip to the bathroom, we can safely say this side effect has been remitted.

Turbo Lax from Dumb and Dumber!

 Complications (sometimes occurring with magnesium overdose) - why she is being monitored so closely: Cardiac arrest, Pulmonary edema (lungs fill with fluid; can be fatal),Chest pain, Cardiac, conduction defects, low blood pressure, low calcium, increased urinary calcium, visual disturbances, decreased bone density, respiratory depression (difficulty breathing),muscular hyperexcitability


Rare, Severe Complications: Profound muscular paralysis, paralytic ileus (intestinal obstruction)

Adapted from: Hill, Washington Clark, "Risks and Complications of Tocolysis," Clinical Obstetrics and Gynecology, 1995, Vol. 38, No. 4, p. 732.

5. Does magnesium sulfate affect my baby or babies?
Yes, it crosses the placenta. After your baby or babies are born, they may have some in their blood.

6. Will I be confined to my bed while on magnesium sulfate?
She wasn't going anywhere. She was restricted to fluids because of the risk of vomiting. She used both a bedpan and was catheterized.


7. Can magnesium sulfate be combined with other preterm labor drugs?
Yes, but there have been some complications. Magnesium sulfate, when combined with nifedipine, can cause neuromuscular blockade (muscular paralysis), so it was combined with Indomethacin.

8. Does magnesium sulfate work?
It stopped the contractions long enough for the cerclage to be done and so she could get on oral meds.

Been on Bed Rest Tooooo Long Top 10 I tweaked from another Blog. 

10. Whenever Mindy needs anything  — a napkin, food, butts wiped — all four yell “DA DA!”
9.  She feels so close to Regis, Kelly, Oprah and The Doctors that she has added them to her birth announcement mailing list.
8.  She develops a vampire-like reaction to sunlight.
7.  Instead of having me wash the sheets, which would require getting out of bed, she has me clean around her with the DustBuster.
6.  She has named the carpet fuzz balls and formed a reading group with them.
5.  There are two grooves in your bed with the inscription, “MINDY'S BUTT WUZ HERE.  FOR A LONG, LONG TIME.”
4.  Your computer gently takes Mindy aside and suggests the two of you “take a break.”
3.  Instead of having dreams about having sex with David Beckham (would be Keith Urban or Brian Williams for Mindy), you have dreams about David Beckham DRIVING YOU TO MCDONALD’S. 
2.  She lets children cover her entire body in stickers.
1.  She looks forward to weekly doctor's appointments as time off for "good behavior".


We'll keep you updated as we get closer to going home and hopefully we'll be singing some Motley Crue's HOME SWEET HOME!