as first line therapy
in the management of tetanus: a prospective study
of 40 patients.
2002 Aug;57(8):778-817 Attygalle D, Rodrigo N.
A prospective observational study was conducted to examine the efficacy and safety of
magnesium sulphate for control of spasms and autonomic dysfunction in 40 patients with tetanus. Magnesium was
infused intravenously, aiming to control spasms despite suppression of patellar reflex
or respiratory insufficiency. Spasms were controlled in 38 of the 40 patients within a serum Mg2+ range of 2-4 mmol.l-1 with only two patients needing additional
neuromuscular blocking drugs. Seventeen of 24 patients (< 60 years) and six of
16 patients (.>/=60 years) did not require ventilatory
support. Thirty-six patients were conscious and co-operative throughout their management. Sympathetic
over-activity was controlled without supplementary sedation.
Overall mortality was 12%; all five deaths were in patients >/= 60 years and no deaths were due to auto-nomic dysfunction. We recommend magnesium as possible first line therapy in the routine management of tetanus.