Cargando…

Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series

INTRODUCTION: Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recen...

Descripción completa

Detalles Bibliográficos
Autores principales: Karanikolas, Menelaos, Velissaris, Dimitrios, Marangos, Markos, Karamouzos, Vassilios, Fligou, Fotini, Filos, Kriton S
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862042/
https://www.ncbi.nlm.nih.gov/pubmed/20356376
http://dx.doi.org/10.1186/1752-1947-4-100
_version_ 1782180692721926144
author Karanikolas, Menelaos
Velissaris, Dimitrios
Marangos, Markos
Karamouzos, Vassilios
Fligou, Fotini
Filos, Kriton S
author_facet Karanikolas, Menelaos
Velissaris, Dimitrios
Marangos, Markos
Karamouzos, Vassilios
Fligou, Fotini
Filos, Kriton S
author_sort Karanikolas, Menelaos
collection PubMed
description INTRODUCTION: Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. CASE PRESENTATIONS: Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition. CONCLUSION: In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports) without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases.
format Text
id pubmed-2862042
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-28620422010-05-01 Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series Karanikolas, Menelaos Velissaris, Dimitrios Marangos, Markos Karamouzos, Vassilios Fligou, Fotini Filos, Kriton S J Med Case Reports Case report INTRODUCTION: Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. CASE PRESENTATIONS: Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition. CONCLUSION: In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports) without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases. BioMed Central 2010-03-31 /pmc/articles/PMC2862042/ /pubmed/20356376 http://dx.doi.org/10.1186/1752-1947-4-100 Text en Copyright ©2010 Karanikolas et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case report
Karanikolas, Menelaos
Velissaris, Dimitrios
Marangos, Markos
Karamouzos, Vassilios
Fligou, Fotini
Filos, Kriton S
Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
title Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
title_full Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
title_fullStr Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
title_full_unstemmed Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
title_short Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
title_sort prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series
topic Case report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862042/
https://www.ncbi.nlm.nih.gov/pubmed/20356376
http://dx.doi.org/10.1186/1752-1947-4-100
work_keys_str_mv AT karanikolasmenelaos prolongedhighdoseintravenousmagnesiumtherapyforseveretetanusintheintensivecareunitacaseseries
AT velissarisdimitrios prolongedhighdoseintravenousmagnesiumtherapyforseveretetanusintheintensivecareunitacaseseries
AT marangosmarkos prolongedhighdoseintravenousmagnesiumtherapyforseveretetanusintheintensivecareunitacaseseries
AT karamouzosvassilios prolongedhighdoseintravenousmagnesiumtherapyforseveretetanusintheintensivecareunitacaseseries
AT fligoufotini prolongedhighdoseintravenousmagnesiumtherapyforseveretetanusintheintensivecareunitacaseseries
AT filoskritons prolongedhighdoseintravenousmagnesiumtherapyforseveretetanusintheintensivecareunitacaseseries