Effect of BMI on serum magnesium level in patient getting Pritchard regimen

ISSN Print – 2454-2334; ISSN Online – 2454-2342 DOI - 10.21276/obgyn.2024.10.2.4 RESEARCH ARTICLE Effect of BMI on serum magnesium level in patient getting Pritchard regimen Noor Islam Ahmed, Milan Kumar Taye, Long Teron, Mohsina Ahmed Corresponding author: Dr Noor Islam Ahmed, Postgraduate Trainee, Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh, Assam, India; Email – Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Background: Maternal death due to severe preeclampsia and eclampsia has significantly reduced in developed countries due to revolutionary management by magnesium sulphate, but it’s still very high in developing countries including India. Many factors including BMI may have significant role in serum magnesium level in patients getting prophylactic and therapeutic treatment with Pritchard regimen. Objectives: To assess the effect of body mass index on serum magnesium level in patients getting magnesium sulphate therapy for seizure prophylaxis. Methods: The study was conducted over one year period from June 2021 to July 2022 in Assam Medical College, Dibrugarh among 160 severe preeclampsia and eclampsia patients who were getting Pritchard regimen. Serum magnesium was measured after loading dose, 3rd dose and 24 hours after last dose. Patients were divided in different groups as per WHO BMI categories. Results: After loading dose mean serum magnesium levels of patients with BMI < 18.5, 18.524.99, 25-29.99 and ≥30 were 3.91±1.09 mg/dl, 3.42± 0.97 mg/dl, 3.20±0.81 mg/dl and 2.77±0.67 mg/dl respectively. Although p- value (0.0616) was not significant but decrease in serum magnesium level was noted with increased BMI. After 3rd dose mean serum magnesium of patients with BMI < 18.5, 18.5-24.99, 25-29.99 and ≥30 were 6.76 ± 0.95 mg/dl, 6.34±1.15 mg/dl, 5.83±1.02 mg/dl and 5.58 ± 1.00 mg/dl respectively. Difference was statistically significant (p=0.0001). Convulsion rate was higher in obese patient (13.04%) compared to non-obese (2.91%). Conclusion: BMI has a significant role on serum magnesium level in pregnant women getting magnesium sulphate therapy for seizure prophylaxis. Keywords: BMI, serum magnesium level, convulsion. BMI of a person is a measure of body fat based on height and weight. It is calculated by weight in kg divided by square of height in meter. According to WHO, person with BMI less than 18.5 is under weight, 18.5 to 24.99 is normal, 25 to 29.99 is overweight and 30 or above is obese. The eighth most prevalent element in the earth's crust is magnesium.1 The periodic table classifies magnesium as an element belonging to group 2 (alkaline earth), and it has a relative atomic mass of 24.305 Da.2 The hydrosphere (ocean and rivers) is the most abundant source of physiologically useable magnesium. The average animal's body has 0.4 g of magnesium per kg.3 In human body average amount of magnesium in a kg of fat-free tissue is said to be around 20 mmol. About 99% of total body magnesium is located in bone, muscles and nonmuscular soft tissue4,5. Intracellular magnesium concentrations range from 5 to 20 mmol/L, extracellular magnesium accounts for ~1% of total body magnesium, which is primarily found in serum and red blood cells (RBCs)3,5. The serum magnesium is either bound to protein, free or ionized, or complexes with anions like phosphate, bicarbonate, citrate, or sulphate. Ionized magnesium has the most biological activity of the three plasma components1. One of the important clinical uses of magnesium is its use Received: 4th March 2023, Peer review completed: 20th May 2023, Accepted: 29th May 2023. Ahmed NI, Taye MK, Teron L, Ahmed M. Effect of BMI on serum magnesium level in patient getting Pritchard regimen. The New Indian Journal of OBGYN. 2024; 10(2): 257 - 61. The New Indian Journal of OBGYN. 2024 (January-June);10(2) in prevention and control of convulsion in preeclampsia and eclampsia. Magnesium sulphate (MgSO4) has been demonstrated to have more efficacy and fewer complications than treatment with diazepam or phenytoin for the treatment of eclamptic seizures. In addition, MgSO4 is superior to placebo and nimodipine for preventing eclampsia in preeclampsia patients 6. Pritchard regimen is one of the widely accepted regimen for magnesium sulphate administration, which was started in 1955. Zuspan intravenous regimen was started in 1964. Magnesium sulphate is administered by intramuscular or intravascular route. 40% of plasma magnesium is protein bound. The unbound magnesium ion diffuses to the extravascularextracellular space, bone, and other tissues and diffuses over placental and fetal membranes, into the fetus and amniotic fluid. In pregnant women, apparent volumes of distribution range from 0.250 to 0.442 L/kg and often achieve consistent levels during the third and fourth hours after administration. The kidneys are crucial in magnesium homeostasis, as serum magnesium concentration is primarily controlled by its excretion in urine2.Almost all of the magnesium that is received is excreted in the urine, with 90% of the dose being eliminated within the first 24 hours of receiving an intravenous MgSO4 infusion. Currently serum magnesium level less than 4.8 mg/dl is considered sub therapeutic, 4.88.4 mg/dl is considered therapeutic and value above 8.4 mg/dl is considered supra therapeutic7. Gestational hypertension: Gestational hypertension is defined as blood pressure of ≥140 / 90 mm Hg on two occasions at least 4 hours apart after 20 weeks of gestation, in a woman with previously normal blood pressure 8. Preeclampsia: It is a disease specific to pregnancy characterised by de-novo development of concurrent hypertension and proteinuria, sometimes progressing into a multiorgan cluster of varying clinical features9. Although proteinuria is one of the important features of preeclampsia, hypertension and other signs and symptoms of preeclampsia may be present without proteinurea10. Severe preeclampsia 11: Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time) with one or more of the following features- thrombocytopenia (platelet count less than 1000000/microlitre), impaired liver function that is not accounted for any alternative diagnosis and as indicated by abnormally elevated blood concentrations of liver enzymes (to more than twice the upper limit of normal concentrations), or by severe persistent right upper quadrant or epigastric pain unresponsive to medications, renal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease), pulmonary edema. Eclampsia: Eclampsia is the occurrence of one or more tonic-clonic generalised seizures in pregnant women with hypertensive disorders that are unrelated to any (...truncated)