During intrapartum care for preeclampsia, a patient develops absent reflexes. What is the most appropriate action?

During intrapartum care for preeclampsia, a patient develops absent reflexes. What is the most appropriate action?

• A. Stop magnesium sulfate and notify the physician
• B. Administer calcium gluconate immediately
• C. Increase IV fluids
• D. Prepare for emergency cesarean

Answer: (A)

Magnesium sulfate toxicity is the key idea here. While giving magnesium sulfate to prevent seizures in preeclampsia, monitoring deep tendon reflexes helps detect rising drug levels. When reflexes become absent, it signals potential toxicity that can progress to respiratory depression and other serious issues. The best immediate action is to stop the magnesium sulfate infusion to halt further magnesium exposure and then notify the physician so orders can be adjusted, and an antidote plan can be considered if needed. Calcium gluconate is the antidote for magnesium toxicity, but it’s used after stopping the infusion and with provider orders; the priority is to discontinue the drug first and involve the physician. Other choices don’t address the urgent issue of suspected toxicity. Increasing IV fluids doesn’t counteract magnesium toxicity and could worsen edema or fluid overload. Preparing for an emergency cesarean isn’t indicated based solely on absent reflexes during magnesium therapy. Administering calcium gluconate immediately is appropriate only after stopping the infusion and under order.

Magnesium sulfate toxicity is the key idea here. While giving magnesium sulfate to prevent seizures in preeclampsia, monitoring deep tendon reflexes helps detect rising drug levels. When reflexes become absent, it signals potential toxicity that can progress to respiratory depression and other serious issues.

The best immediate action is to stop the magnesium sulfate infusion to halt further magnesium exposure and then notify the physician so orders can be adjusted, and an antidote plan can be considered if needed. Calcium gluconate is the antidote for magnesium toxicity, but it’s used after stopping the infusion and with provider orders; the priority is to discontinue the drug first and involve the physician.

Other choices don’t address the urgent issue of suspected toxicity. Increasing IV fluids doesn’t counteract magnesium toxicity and could worsen edema or fluid overload. Preparing for an emergency cesarean isn’t indicated based solely on absent reflexes during magnesium therapy. Administering calcium gluconate immediately is appropriate only after stopping the infusion and under order.