Reversible High-Degree Atrioventricular Block Associated With Magnesium Toxicity in Severe Pre-Eclampsia.
Alex F Lwiza, Edward Thomas, Nasra Batchu et al.
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Case in brief
A 35-year-old woman at 31 weeks and 5 days of gestation presented with severe pre-eclampsia and acute kidney injury. Following a standard magnesium sulfate regimen, she developed symptomatic hypermagnesemia and 2:1 second-degree atrioventricular block. After discontinuation of magnesium sulfate, administration of intravenous calcium gluconate, and emergency cesarean delivery, the atrioventricular block resolved, and the mother recovered well.
What made this case unusual
The case illustrates a rare but reversible manifestation of magnesium toxicity in the context of severe pre-eclampsia, particularly in a patient with acute kidney injury.
Diagnostic / clinical pearl
Clinicians should be vigilant for signs of magnesium toxicity, especially in pregnant patients with renal impairment receiving magnesium sulfate.
Why it matters
Early recognition and management of magnesium toxicity can prevent serious cardiac complications in patients with pre-eclampsia.