Use of magnesium sulfate in neurology

The role of magnesium sulfate in the intensive care of neurological complications

In clinical practice, infectious diseases of the central nervous system (e.g., mumps in children) are frequently accompanied by severe neurological complications such as meningitis and meningoencephalitis. Since there is no specific antiviral treatment for such infections, therapy is primarily pathogenetic and symptomatic. When seizures develop, anticonvulsants play a key role. Magnesium sulfate (Magnesii sulfas) is one of the baseline agents for controlling seizures within a syndromic approach.

In pediatric practice, a 25% magnesium sulfate solution is traditionally used. The dosage is calculated strictly on an individual basis, depending on the patient's age: the standard protocol involves administering 1 ml of solution per year of life of the child. To achieve maximum clinical efficacy and rapidly suppress pathological seizure activity, magnesium preparations are frequently combined with benzodiazepine tranquilizers. Specifically, diazepam is prescribed, at a dose ranging from 0.3 to 2 ml depending on the patient's age.

Comprehensive syndromic approach and adjunctive therapy

The use of anticonvulsants, including magnesium sulfate, is only one component of comprehensive treatment. Patients with severe complications require mandatory hospitalization. Therapy is built on a syndromic approach and must include management of cerebral edema and marked intoxication.

• Dehydration therapy: aimed at eliminating cerebral edema. Includes the use of loop diuretics (furosemide prescribed at 1–2 mg/kg) and osmotic diuretics (mannitol 0.5–1 g/kg). These drugs are used in strict combination with glucocorticosteroids — dexamethasone or prednisolone — administered intravenously or intramuscularly at 3 mg/kg.
• Detoxification therapy: involves intravenous infusions of colloidal solutions (fresh frozen plasma, 10% human albumin solution at 10 ml/kg) and glucose-electrolyte mixtures (10% dextrose solution at 10 ml/kg). Children over one year of age are additionally indicated to receive meglumine sodium succinate.

It is important to note that the general principles of rehydration therapy in children are based on an accurate calculation of fluid volume. It consists of three components: baseline physiological requirement by age, existing fluid deficit volume, and ongoing pathological losses. The route of administration (enteral or parenteral) is determined exclusively by the severity of the child's condition.

Baseline therapy, common pitfalls, and prognosis

In addition to intensive care, patients with neurological complications require baseline support. This includes strict bed rest, thorough oral hygiene, and a sparing diet. During the first few days, food should be liquid or semi-liquid, predominantly dairy and plant-based; raw vegetables, fruits, and fresh bread are excluded to reduce stimulation of the salivary glands. For hyperthermia, antipyretics are prescribed symptomatically.

Physicians should avoid common pitfalls: routine administration of antibiotics for a viral etiology is an erroneous tactic (they are indicated only if secondary bacterial flora joins). Unjustified use of immunomodulators is also inappropriate.

The efficacy of magnesium sulfate and other therapeutic components directly impacts the outcome:

1. In meningitis: with adequate treatment, the prognosis is favorable. Clinical improvement occurs on days 5–7, and complete cerebrospinal fluid (CSF) clearance by days 10–12.
2. In meningoencephalitis: the prognosis is grave, characterized by high mortality and the risk of developing severe neuropsychiatric deficits.

Upon discharge from the hospital, the patient is referred for mandatory follow-up by a neurologist at the local outpatient clinic. If residual effects are present, symptomatic treatment is prescribed.

Class and exam questions

What else to study on this topic

• Principles of dehydration therapy and diuretic dose calculation
• Detoxification therapy: choice of colloidal and crystalloid solutions
• Clinical features of meningitis and meningoencephalitis
• Residual neurological symptoms and their symptomatic treatment
• Criteria for cerebrospinal fluid (CSF) clearance

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.