MgSO4 Toxicity Pre-eclampsia AKI — ESENeph MCQ

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ModeratePregnancy & RenalMgSO4 Toxicity Pre-eclampsia AKIESENeph

A 38-year-old woman develops pre-eclampsia at 32 weeks with severe features (BP 170/110, proteinuria 6 g/day, headache, visual disturbance). She is given IV Magnesium Sulphate for seizure prophylaxis. What renal consideration is important with MgSO4?

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Correct answer: C — Monitor for magnesium accumulation and toxicity

IV Magnesium Sulphate is renally excreted. In pre-eclampsia, AKI is common (occurring in up to 5-10% of severe cases), and impaired renal clearance can lead to magnesium accumulation and toxicity. Signs of toxicity include loss of deep tendon reflexes, respiratory depression, and cardiac arrest. NICE NG133 recommends monitoring clinical signs (patellar reflexes, respiratory rate, urine output) and serum magnesium levels, especially if urine output falls below 100 mL over 4 hours. Dose reduction or cessation may be needed. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG133 2019 – Hypertension in Pregnancy; RCOG 2024 – Pre-eclampsia: https://ukkidney.org/health-professionals/guidelines/clinical-practice-guideline-pregnancy-and-renal-disease