Question
A G2P1 at 38 weeks gestation with severe preeclampsia is undergoing induction of labor. She suddenly experiences a generalized tonic-clonic seizure. The bedside nurse immediately administers a 4 g IV bolus of Magnesium Sulfate over 5 minutes. Two minutes later, while the patient is in the postictal phase, she has a second generalized tonic-clonic seizure. What is the correct immediate pharmacological step according to ACOG guidelines?
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If a patient experiences a recurrent seizure while already receiving or immediately following the initial Magnesium Sulfate loading dose, the correct immediate step is to administer an additional bolus of 2 g of Magnesium Sulfate IV given over 3 to 5 minutes. Concurrently, check the maintenance infusion rate to ensure it is running at 2 g/hour. If seizures continue despite this secondary magnesium bolus, alternative anticonvulsants must be utilized, such as a slow IV push of Loratadine/Diazepam, Midazolam (1 to 2 mg IV), or Levetiracetam (Keppra), alongside securing the maternal airway and verifying that hypoxia is not the driving cause.
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