E-drug: Magnesium sulphate in Eclampsia (cont)
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A major problem in getting access to magnesium sulphate in many
low-income-countries is that it is a cheap drug and so many of the
pharmaceutical companies do not want to manufacture it since the profit is
miniscule.
A major teaching hospital in a low-income-country which was part of the
multicentre randomized controlled trials that showed convincingly its
superiority over alternatives in treating eclampsia was itself unable to
obtain supplies once the trials were over.
Because of the problem of access and the clear benefits of the drug I have
been investigating alternatives until supplies are assured. Here is my
suggestion for peripheral hospitals in low-income-countries who are unable
to obtain it from other sources:
In a crisis situation with very limited resources and no possibility of
referral, you can make up 50% magnesium sulphate solution using water for
injection and ordinary epsom salts (which is Magnesium sulphate
heptahydrate) usually available in every pharmacy in developing countries
for treatment of constipation. Mix crystals or powder of Epsom salts with
an equal weight of water for injection (i.e. the same number of mls as the
Epsom salts are in grams). Autoclave this solution and then administer the
cooled liquid by i.m. injection.
This suggestion although a poor alternative to standard treatment may save
many lives. The only small problem is some minor febrile reactions since
the mixture is made up of ingredients which have not been totally freed
from pyrogens.
Gunnar Holmgren
Consultant in International Health Care
Sweden
"Gunnar.Holmgren@ich.uu.se" <Gunnar.Holmgren@ich.uu.se>
{manually added by moderator. Physical address was not supplied. BS]
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