Pearls & Oy‐sters: Reversible Postpartum Pseudocoma State Associated With Magnesium Therapy

Magnesium (Mg) competes with calcium in normal synaptic transmission, inhibiting neurotransmitter release. As a drug, it is usually given as a treatment for eclampsia and pre-eclampsia. Two eclamptic pregnant women treated with Mg developed a pseudo-coma state immediately after emergency Caesarian Section. The clinical presentation was flaccid quadriparesis, areflexia, an absence of absent respiratory effort and vestibular-ocular reflexes, but with preserved pupillary responses. Decremental responses on repetitive nerve stimulation were found in both women. Recovery was obtained after cessation of the Mg. The persistence of pupillary reflexes in the absence of reflexes involving striated muscles was an important clinical clue, indicating neuromuscular junction dysfunction.