September-October 2015 · Volume 4 · Issue 5 Page 1552 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Ganaw A et al. Int J Reprod Contracept Obstet Gynecol. 2015 Oct;4(5):1552-1554 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Stridor: a rare complication of magnesium sulfate therapy in a pregnant patient Adel Ganaw 1 *, Nissar Shaikh 1 , Tawfiq Abu-Aisha 1 , Raphael Samuel 2 , Firdous Ummunnisa 3 INTRODUCTION Preeclampsia and eclampsia is a life threatening disorder affecting 2-8% of pregnancies. Magnesium sulfate is commonly used in Preeclampsia and eclampsia for prevention of seizure activity. 1 But this therapy is not free from complications, usually minor adverse effects such as nausea, vomiting, muscle weakness, dizziness but can be major side effects such as respiratory depression and tetany. 1 Rarely the hypocalcemia caused by magnesium sulfate therapy can lead to laryngospasm, which is not reported in the literature. We report a case of stridor due to hypocalcemia caused by the magnesium sulfate therapy in a pregnant patient. CASE REPORT A 30 year South African black lady, gravida 5, para 3+1 , presented with sever preeclampsia (BP 215/145 mmHg, proteinuria +2), and preterm premature rupture of membrane at 33 weeks of gestation. Her cardiovascular and respiratory examination was unremarkable. Past medical history she was known case of HIV, CD4 was unknown, she wasn't on ARVS therapy. Up on presentation, she was given 10 grams magnesium sulfate (Mg. Sulfate) intramuscular, followed by 2 grams/hour intravenous Mg sulfate as a maintenance, as well as antibiotic and course of Betamethasone. Blood pressure was dropped to 145/95 mmHg, the investigations (FBC, urea, creatinine, electrolytes, LFT, coagulation screen) were done, it showed raised serum creatinine 115 mmol/l, and liver enzymes LDH 1433 1 Department of anaesthesia/ICU perioperative Med: Hamad Medical Corporation. Doha-Qatar 2 University of Kwa Zulu Natal, Durban: South Africa 3 OBGY department AKH, Hamad Medical Corporation: Doha-Qatar Received: 23 April 2015 Accepted: 10 May 2015 *Correspondence: Dr. Adel Ganaw, E-mail: adelganaw@yahoo.co.uk Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Magnesium sulfate is frequently used in severe preeclampsia and eclampsia for the prevention and reoccurrence of seizure activity. Their adverse effects of magnesium sulfate are minor but it cause respiratory depression and tetany. We report a case of stridor due to laryngospasm as result of hypocalcemia in a pregnant patient on magnesium sulfate therapy. A 30 year old gravida5 para 4 had severe preeclampsia started on magnesium sulfate therapy and to control her hypertension she was on labetalol and nifidipine. One hour after the lower segment cesarean section, she developed severe laryngospasm and stridor, no upper airway secretion but found to have hypocalcemia. She responded to immediate intravenous calcium chloride with dramatic clinical improvement. Patients on magnesium sulfate can have life threatening hypocalcemia and stridor. The calcium channel blockers may augment the hypocalcaemic effect of magnesium sulfate. Keywords: Calcium channel blockers, Eclampsia, Hypocalcemia, Laryngospasm, Magnesium sulfate, Preeclampsia and stridor DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150744