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Treatment of tetanus in childhood with MgSO4 - benefits and risks

Eleonora Zheleva, Ðœergyul Halilova, Violeta Iotova, Darina Krumova, Nadezhda Ilieva, Nadezhda Dimitrova, Darina Zlatkova, Marin Marinov, Yana Bocheva


Tetanus is an acute infectious disease characterized by clinical triad muscle rigidity, muscle spasm and dysfunction of the autonomic nervous system. The management of the painful, protracted muscle spasm and rigidity is a basic element in the treatment of tetanus. Numerous medications such as benzodiazepines, opiates, propofol, dantrolene, baclofen, muscle relaxants have been used in clinical practice. An alternative agent is MgSO4.

We present a clinical case of tetanus in a 12-year-old child, in which a prolonged intravenous infusion of MgSO4 was used for the first time at our intensive care unit. The drug was used to control muscle spasms in combination with Dormicum, Tilidine and Baclofen. With the addition of MgSO4 to the therapy, we managed to control muscle spasms and to reduce rigidity, avoiding increase in the doses of the sedative and opiate, as well as endotracheal intubation followed by tracheostomy, mechanical ventilation and muscle relaxation.

The decision to present our experience of managing tetanus by application of continuous i.v. infusion with MgSO4 was due to the fact that only single clinical cases were described in the literature. Furthermore, the indicated doses were too variable, perhaps because the children were with varying severity of tetanus, with or without supportive artificial lung ventilation. These facts motivated us to describe our clinical case in detail in order to support future local clinical practice.


tetanus; magnesium sulfate; childhood

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