Bed rest with seizure precautions

Vital signs (blood pressure, pulse, respiration); deep tendon reflexes; and mental status every 15 to 60 minutes until stable, then every 60 minutes while on magnesium sulfate

Accurate intake and output; Foley catheter if needed

Administer lactated Ringer's solution at 75 mL per hour IV to maintain urine output of 30 to 40 mL per hour; total intake (IV and oral) should not exceed 125 mL per hour or 3,000 mL per day

Continuous fetal heart rate monitoring⁷

Laboratory tests

Dipstick urine collection for protein level on admission

24-hour urine collection for total protein level

CBC with platelets, peripheral blood smear

BUN, creatinine, uric acid

AST, ALT, LDH

Fetal evaluation: nonstress test on admission; obstetric ultrasonography for estimated fetal weight, amniotic fluid volume, and umbilical artery Doppler measurements

Medications

Magnesium sulfate

Loading dose of 4 to 6 g diluted in 100 mL of normal saline, given IV over 15 to 20 minutes, followed by a continuous infusion of 2 g per hour¹²

Assess serum magnesium level if urine output is < 30 mL per hour or there is a loss of deep tendon reflexes, decreased respiratory rate, or altered mental status

Therapeutic range for serum magnesium is 4 to 7 mg per dL

Corticosteroids (if between 24 and 34 weeks of gestation and not previously administered)

Betamethasone (Celestone), 12 mg IM initially, then repeat in 24 hours

or

Dexamethasone, 6 mg IM initially, then repeat every 12 hours for three additional doses

For systolic blood pressure > 160 mm Hg or diastolic > 110 mm Hg, one of the following should be given to achieve a systolic measurement of 140 to 155 mm Hg and/or a diastolic measurement of 90 to 105 mm Hg⁷:

Hydralazine, 5 to 10 mg IV every 15 to 30 minutes (maximal dose: 30 mg)⁷

or

Labetalol, 20 mg IV initially; if the initial dose is not effective, double the dose to 40 mg and then 80 mg at 10-minute intervals until target blood pressure is reached or a total of 220 mg has been administered^1,7; the maximal dose of IV labetalol is 220 mg in a 24-hour period^7,12

Calcium gluconate, 1 g IV; keep at bedside in case of respiratory depression from magnesium sulfate use