Pilot Study of Magnesium Sulphate in Adults with Tetanus

Background: Recent data suggests that Magnesium sulhate alone improves clinical outcome in tetanus, but this as not been confirmed. Aim: To examine the efficacy and safety of intravenous agnesium sulphate for control of rigidity, spasms and autoomic instability in tetanus. Methods: This was a pilot prospective clinical study of ntravenous magnesium sulphate in 35 consecutive adult atients with tetanus over a period of two years in a teriary teaching hospital. All patients received human tetanus mmunoglobulin, tetanus toxoid and parenteral antibiotics. ntravenous magnesium sulphate 20 mg/kg was adminisered followed by 1.0 mg/hr infusion. The infusion rate was ncreased by 0.5 mg/hr every two hours until cessation of pasms or abolishment of patellar tendon jerk, whichever ccurred earlier. The primary outcome measure was effiacy determined by control of spasms (defined as less than wo brief spasms within 60 minutes). Secondary outcomes ncluded frequency of autonomic instability, duration of venilatory support, hospital stay and mortality. Results: At presentation, the frequency of severity of etanus was as follows: Grade I: 5 (14%), Grade II: 13 (37%), rade III: 16 (46%) and Grade IV: 1 (3%). Rigidity and mild pasms were controlled with magnesium therapy 6 patients 17%), all were Grades I and II. Grading worsened in 22 atients (63%), and remained static in the rest. 17 patients eveloped autonomic instability while on magnesium infuion. The average duration of ventilatory support required as 18.3 + 16.0 days whereas the mean hospital stay was 0.8 + 16.7 days. The overall mortality was 22.9%. Asympomatic hypocalcemia was a universal finding. Conclusion: Magnesium sulphate therapy alone cannot be onsidered efficacious for the treatment of tetanus.