حامل عندها تسمم حمل شديد على تسريب سلفات المغنيسيوم. تنفسها الآن ١٠ في الدقيقة، ومنعكس الركبة غائب، والبول ٢٠ مل/ساعة. ما أول إجراء؟

A woman with severe pre-eclampsia is on a magnesium sulfate infusion. Her respiratory rate is now 10, patellar reflexes are absent and urine output is 20 mL/h. What is the first action?

1. Give IV calcium gluconate
2. Stop the magnesium infusion
3. Give furosemide to increase urine output
4. Increase the rate to prevent seizures

Answer: B) Stop the magnesium infusion. Low respiratory rate, absent reflexes and oliguria are signs of magnesium toxicity, and the first step is stopping the source. The antidote calcium gluconate then follows per order, with respiratory support. Increasing the rate worsens toxicity, and a diuretic is not the treatment.