Back to Basics: Eclampsia

A 28 year old woman comes into your community rural ED, only medical history is she had a baby 15 days ago.  Says she’s been feeling unwell for the past week and begins to seize - what do you do? 


What is preeclampsia?  HTN + end organ damage 

  • proteinuria (> 300 mg / 24 hr, protein/creatinine > 0.3, dipstick > 2+) 

  • AKI (Cr >1.1 or doubling of baseline) 

  • liver dysfunction (2 x normal) 

  • hemolysis  

  • thrombocytopenia 

  • neurological features (headaches, vision changes, etc) 


Eclampsia? Preeclampsia + Seizures  

  • the danger? Can be initially asymptomatic, can be seen in women up to 6 weeks postpartum 


What to do? 

  • if patient is preeclamptic 

  • consult OB: treatment is delivery 

  • magnesium for seizure prophylaxis (until 24 hours after delivery) 

  • 6g of 10% solution bolus 15-20 min, 2g/hour infusion after until 24 hour  after delivery 

  • CONTRAINDICATED in myasthenia gravis patients, use other antiepileptics (levetiracetam or valproic acid) 

  • treat the hypertension: labetalol, nifedipine, methyldopa  

  • No IV? IM magnesium: 50% concentration, 5mg in each buttock, then 5mg in each buttock Q4 until 24 hour after delivery 




Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018 Jul;72(1):24-43. doi: 10.1161/HYPERTENSIONAHA.117.10803. PMID: 29899139. 


Gestational Hypertension and Preeclampsia, Obstetrics & Gynecology: June 2020 - Volume 135 - Issue 6 - p 1492-1495 

doi: 10.1097/AOG.0000000000003892  


Tintinalli, Judith E.,, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. Eighth edition. New York: McGraw-Hill Education, 2016. 


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