Proper prenatal care is essential so dont miss your appointments. Unable to load your collection due to an error, Unable to load your delegates due to an error, Clinical Methods: The History, Physical, and Laboratory Examinations. Eliminating alcohol and any medication not prescribed by a physician is essential. The use of magnesium sulfate helps prevent seizures in women with preeclampsia.3840 One eclamptic seizure is prevented for every 100 women treated.38 The use of magnesium sulfate is controversial in women with mild preeclampsia because the incidence of eclamptic seizures is only 0.5 percent in these patients. Proper technique of reflexes examination and experience play a major role in eliciting and categorizing deep tendon reflexes. In rural or remote areas, physicians need to consider the risk of transfer versus the benefits of tertiary maternal and neonatal care. Monitor vital signs and FHR. Monitor reflexes closely: absent or diminished reflexes often first sign of toxicity, clonus (series of involuntary muscular contractions and relaxations) ), To check for ankle clonus: quickly dorsiflex the patients foot (point toes upward) and see responseif positive (clonus) foot will start to bounce back and forth (it attempts to plantarflex) >3 bounces or more is positive, eclampsiaearly may see facial twitching, changes in neuro status, followed by full body tonic-clonic seizure (contraction and stiffening of body followed by jerking of muscles), Stay with patient and get help, dont restrain patient, get on left side (helps prevent aspiration, opens airway, and helps with blood flow to placenta), oxygen 8 to 10 L, monitor baby, timing and characteristics of seizure, may need medication and delivery of babydelivery of baby tends to be the treatment to help but can have seizures after delivery), watch salt intake (sodium levels can increase due to renal dysfunction and start to keep sodium in the blood). HELLP Syndrome: hemolysis (rupture of RBCs), elevated liver enzymes, low platelets. Headaches Blurry vision Change in behavior Fatigue Change in balance or coordination Numbness or tingling in the arms or legs Decrease in movement of the arms or legs Injury to the head, neck, or back Temperature of unknown source Seizures Slurred speech Weakness Tremor What is done during a neurological exam? The cerebral cortex and a number of brainstem nuclei exert influence over the sensory input of the muscle spindles by means of the gamma motoneurons that are located in the anterior horn; these neurons supply a set of muscle fibers that control the length of the muscle spindle itself. Nerve biopsy should be considered when the diagnosis remains uncertain after laboratory and electrodiagnostic testing, or when confirmation of the diagnosis is needed before initiating aggressive treatment (e.g., in cases of vasculitis when steroids or chemotherapy is used). Fetuses older than 34 weeks, or those with documented lung maturity, are also delivered without delay.7, For patients with severe preeclampsia between 24 and 34 weeks of gestation, the data are insufficient to recommend interventionist versus expectant management.47 Subspecialty consultation is indicated.48,49 Corticosteroids are administered to accelerate fetal lung maturity.7 Interventionist management advocates induction or cesarean delivery 12 to 24 hours after corticosteroid administration. Do not be afraid to question your caregiver if any of these tests are omitted. government site. (Learn how to take your blood pressure.). This further complicates things because it decreases blood volume. Therefore, its important to know how to detect this condition in a pregnant patient. Determination of fetal lung maturity for delivery This is because preeclampsia temporarily damages this filter. Albumin, as well as many other proteins, are lost this way. Graded to +2. ("Your Blood Pressure: Know the Basics"). An overdose of magnesium sulfate may suppress or excessively slow your reflexes. The aroused receptors initiate the reflex arc, causing the muscle to move. Brisk reflexes describe an instance where the muscles contract more strongly or more . Hyperreflexia is when your reflexes are so strong that when your knee is tapped by a rubber hammer, your leg bounces back hard. Magnesium sulfate is more effective than diazepam (Valium; NNT = 8) or phenytoin (Dilantin; NNT = 8) in preventing recurrent eclamptic seizures. With preeclampsia, the blood pressure is usually normal at the beginning of the pregnancy, but around 20 weeks gestation it starts to elevate. The damaged endothelial cells fail to function properly and cause: Hypertension: damaged endothelial cells lose their tone, therefore, vasospasm (contraction of the vessel) starts to occur and this leads to increase pressure within the vesselhence causes hypertension, Proteinuria: this is due to kidney injurythe kidneys are being deprived of proper blood flow and endothelial cells that line the glomerulus (this structure filters the blood and it normally does NOT filter large molecules like protein) are damaged. His deep tendon reflexes are exaggerated. Deep Tendon Reflexes In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle. And even if it's not a symptom of preeclampsia, it can still be a sign of a problem. Magnesium sulfate and transmitted securely. The grasp reflex is present if gently stroking the palm of the patient's hand causes the fingers to flex and grasp the examiner's . This was reasonable. Lumbar puncture and cerebrospinal fluid analysis may be helpful in the diagnosis of Guillain-Barr syndrome and chronic inflammatory demyelinating neuropathy. Copyright 2023 American Academy of Family Physicians. See our full, Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), IV Drug Use Complications & Dangers: (Endocarditis, Infection, Infectious Diseases). Let's raise up our voices so more women know about preeclampsia and HELLP syndrome and less women have adverse outcomes! Did you discuss this with your doctor at the time of exam? The increased glomerular filtration rate of pregnancy lowers serum creatinine, and levels greater than 0.9 mg per dL (80 mol per L) are abnormal in pregnancy. We will discuss more about this in the pathophysiology section, which will correlate with the signs and symptoms you will see in the patient. The rooting reflex is present if stroking the lateral upper lip causes movement of the mouth toward the stimulus. It is our collective voice that reduces isolation for others, raises awareness and improves healthcare practices. In the case of a protein-creatinine ratio (another way to measure proteinuria), 0.3 generally corresponds to 300 mg in a 24-hour collection. Use as a tocolytic for up to 48 hours for short-term prolongation of pregnancy for the administration of antenatal corticosteroids in women . That means using your smart phone camera or just a reg A new study recently published by the New England Journal of Medicine found that women at high risk for preterm preeclampsia who took aspirin were less likely to develop the condition than women who w What is AFLP? +4= Hyperactive reflex; clonus may also be present, +1 Minimal edema of lower extremities Hyporeflexia is an absent or diminished response to tapping. A more recent article on hypertensive disorders of pregnancy is available. There are five primary deep tendon reflexes: biceps, brachioradialis, triceps, patellar, and ankle. One fourth of women will experience adverse effects, especially flushing.42 Table 5 outlines the standard dosing regimen.1,7,12 Serum magnesium levels should be monitored in women with elevated serum creatinine levels, decreased urine output, or absent deep tendon reflexes.43 Magnesium toxicity can lead to respiratory paralysis, central nervous system depression, and cardiac arrest. +1= Reflexes present, hypoactive Normally, the bicep muscle will immediately contract. It is important to help patients control troublesome symptoms of peripheral neuropathy, such as severe numbness and pain, as well as to alleviate disability resulting from weakness.12 Several pharmacologic options exist to treat neuropathic pain, including some antiseizure medications (e.g., gabapentin [Neurontin], topiramate [Topamax], carbamazepine [Tegretol], pregabalin [Lyrica])13,14 and antidepressants (e.g., amitriptyline).1517 Topical patches and sprays containing lidocaine (Lidoderm) or capsaicin (Zostrix) also may relieve pain in some patients.18 Other supportive measures, such as foot care, weight reduction, and shoe selection, may also be helpful.2 Narcotics may have a role in the treatment of chronic neuropathic pain in selected patients19; candidates initially should be evaluated for their risk of substance abuse and addiction, and several nonnarcotic regimens should be tried first. You should also put your feet up every day, but avoid sitting for extended periods of time. If you own your own monitor, have it calibrated with those used in your providers office. The height adjusted Treflex was abnormal in 25 (96%) cases, including 6 of 7 patients with brisk or normal reflexes on clinical testing. Tiny clots form in the tiny blood vessels blocking blood flow to the organs and causing ischemia Paraneoplastic panel (anti-Hu, anti-Yo, anti-Ri, anti-Tr, anti-Ma, and anti-CV2 antibodies), Mainly demyelinating, especially in viral hepatitis, Hepatic transaminase, bilirubin, albumin, and alkaline phosphatase levels, Fasting blood glucose level, glucose tolerance test, A1C level, Serum creatinine and blood urea nitrogen levels, Usually acute or subacute, but can be chronic, Phenolic glycolipid-1 antibody, skin biopsy, Urine and serum protein electrophoresis with immunofixation, Axonal damage predominates after treatment, Monoclonal gammopathy of undetermined significance, Rapid plasma reagin, VDRL, cerebrospinal fluid analysis, Peripheral neuropathy is intermixed with upper motor neuron signs, Neuropathy with liability to pressure palsies, Heavy metals (e.g., arsenic, lead, mercury, gold), Lead and mercury mainly cause motor neuropathy, 24-hour urine collection for heavy metal titers, Urinalysis (including 24-hour urine collection), Heavy metal toxicity, porphyrias, multiple myeloma, Antimyelin-associated glycoprotein and antiganglioside antibodies, Salivary flow rate, Schirmer test, rose bengal test, labial gland biopsy, Acute or chronic inflammatory demyelinating neuropathy. Consumption of clotting factors and circulating blood unable to clot, Eliminate cause, delivery of infant The damage and clinical manifestations are usually located distally with a proximal progression. A certain amount of swelling is normal during pregnancy. Pages 461 A symptom is something you may experience and recognize, such as a headache or loss of vision. Clonus reflex is a set of rhythmic, involuntary muscle movements. Your doctor or midwife has asked you to use telehealth for some of your check-ups. A common regimen for expectant management of mild preeclampsia is outlined in Table 4.1,7 Nonstress tests, amniotic fluid index measurements, and biophysical profiles are used to monitor patients for uteroplacental insufficiency.1,7 Umbilical artery systolic/diastolic ratios measured by Doppler ultrasonography may detect early uteroplacental insufficiency.36,37 The decision to deliver involves balancing the risks of worsening preeclampsia against those of prematurity. A reflex hammer can be used to test the deep tendon reflexes in various muscles, including the bicep muscle of the arm. The nurse plays a vital role in helping detect these conditions. Fetal factors include gestational age, evidence of lung maturity, and signs of fetal compromise on antenatal assessment. Would be significant if not present or you had other signs to asso Is a dangerous thing. Aqu encontrar todo lo que necesita saber sobre cmo tomarse la presin arterial en casa. What is considered proteinuria for preeclampsia? Abnormal placental implantation (defects in trophoblasts and spiral arterioles), Angiogenic factors (increased sFlt-1, decreased placental growth factor levels), Cardiovascular maladaptation and vasoconstriction, Genetic predisposition (maternal, paternal, thrombophilias), Immunologic intolerance between fetoplacental and maternal tissue, Vascular endothelial damage or dysfunction, Preeclampsia in a previous pregnancy (particularly if severe or before 32 weeks of gestation), Blood pressure 160 mm Hg systolic or 110 mm Hg diastolic on two occasions at least six hours apart during bed rest, Proteinuria 5 g in a 24-hour urine specimen or 3+ or greater on two random urine specimens collected at least four hours apart. At 15 mEq/L, signs of abnormal conductivity surface as SA/AV node block. #shorts #anatomy, >140/90 (>140 mmHg systolic & >90 mmHg diastolic), Is one reading sufficient? Upper abdominal pain and increase in liver enzymes (AST and ALT): the liver is affected due to decrease perfusion and swelling. Somatosens Mot Res. If you are under treatment with magnesium sulfate to prevent seizures, your healthcare provider may also test your reflexes to monitor for the need to start, adjust or stop the magnesium treatment. During late pregnancy, you may be advised to lie on your left side to prevent restriction on certain veins which could also contribute to elevated blood pressure. Call your health professional immediately. Monitor urine output closely: concerned if <30cc/hr, Foley, I+0 Absent reflexes are seen when a patient develops magnesium toxicity, 0= Reflexes absent PG, Tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The effect of stimulation of Golgi tendon organs and spindle receptors from hindlimb extensor muscles on supraspinal descending inhibitory mechanisms. It is important to avoid unnecessary interventions and iatrogenic complications.43,53 Magnesium sulfate is the drug of choice because it is more effective in preventing recurrent seizures than phenytoin (Dilantin) or diazepam (Valium).39,5456 If a patient has already received a prophylactic loading dose of magnesium sulfate and is receiving a continuous infusion, an additional 2 g should be given intravenously. DIC allows excess bleeding from any vulnerable site: incisions, IV site, gums, nose, urine, ecchymoses In this review you will learn about: Whats Preeclampsia? Deep tendon reflexes are usually brisk, and muscle tone is spastic. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. School Irvine Valley College; Course Title NUR 120; Uploaded By neilpatel315. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Edema (eyes, face, extremities, pulmonary edema, increase weight gain, cerebral edema): the increase in permeability of the endothelial cells causes protein to escape the vessel. Most patients with preeclampsia respond promptly to delivery with decreased blood pressure, diuresis, and clinical improvement. Eclampsia may occur postpartum; the greatest risk of postpartum eclampsia is within the first 48 hours.43 Magnesium sulfate is continued for 12 to 24 hours, or occasionally longer if the clinical situation warrants. Rationale: The normal potassium level is 3 to 5 mEq/L (3 to 5 mmol/L). Lesions of the peripheral nerve roots are typically asymmetric, follow a dermatomal pattern of sensory symptoms, and may have associated neck and low back pain. Hemolysis, Elevated Liver enzymes, Low Platelets A nurse will have dipped a reagent strip into a sample of your urine. Nausea or vomiting can be confused with the flu or gallbladder problems, so insist on getting your blood pressure checked and checking your urine for proteinuria. Calcium supplementation decreases the incidence of hypertension and preeclampsia, respectively, among all women (NNT = 11 and NNT = 20), women at high risk of hypertensive disorders (NNT = 2 and NNT = 6), and women with low calcium intake (NNT = 6 and NNT = 13). please help im his mother? Deep tendon reflexes demonstrate the homeostasis between the cerebral cortex and the spinal cord. However, if the reading is 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is below 140/90. Antidote for MgSo4 toxicity is calcium gluconate: should be available at bedside: 1gm IV given over 3 minutes During your prenatal visits do not attempt to disguise weight gain by skipping breakfast, using diet pills or fasting for the day. The American College of Obstetricians and Gynecologists (ACOG) sets the guidelines for preeclampsia. Excessive dietary protein may cause problems in women with underlying kidney disease. The oxygen deprived placenta does not like this and becomes stressed out so it releases substances into moms circulation in hopes of increasing blood flow to it. Pregnancy is a confusing time. HEND AZHARY, MD, MUHAMMAD U. FAROOQ, MD, MINAL BHANUSHALI, MD, ARSHAD MAJID, MD, AND MOUNZER Y. KASSAB, MD. A maternal blood pressure measurement of 140/90 mm Hg or greater on two occasions before 20 weeks of gestation indicates chronic hypertension. . Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia. This was indicated by order. A 128-Hz tuning fork should be used to test the vibratory sensations in extremities. The .gov means its official. Treasure Island (FL): StatPearls Publishing; 2022 Jan. insidious onset, visible bleeding, bright red blood, painless, soft contender uterus, normal FHR, normal vitals, decreased urine output Findings of Abruptio placentae sudden onset, concealed or visible, dark red blood, constant sharp, firm rigid uterus, fetal distress, contractions with hypertonicity, clinical findings of hypovolemic shock Axonal loss leads to lower amplitudes, and demyelination causes prolonged latency and slow conduction velocity. The damaged cells of the glomerulus start to leak protein from the blood into the urine causing proteinuria. If you have tried taking over-the-counter medication without relief, if the headache is very painful, you have light sensitivity, or if your headache is accompanied by vision changes (please read the section below on "Changes in Vision") call your provider immediately and ask to see him/her that day. You checked the deep tendon reflexes. Any of the following associated signs and symptoms: Abnormal peripheral blood smear (evidence of damaged erythrocytes, such as schistocytes and burr cells), Serum bilirubin 1.2 mg per dL (21 mol per L), Obtain laboratory tests weekly: CBC, platelet count, ALT, AST, LDH, uric acid, creatinine, Assess for proteinuria: screen with dipstick or spot protein/creatinine ratio and obtain periodic 24-hour urine collections, Measure amniotic fluid index once or twice weekly, Biophysical profile may be done weekly in place of one of the twice-weekly nonstress tests and amniotic fluid index, Perform ultrasonography for fetal growth every three to four weeks. like going from 2+ to 4+ on a scale that goes to 5+. Unexplained pain. Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. Accessibility Triceps, biceps, patellar (k. Read More It tends to occur after 20 weeks of gestation, which is the halfway point of a typical 40 week pregnancy. Deep tendon reflexes in pregnancy A 40-year-old member asked: What are deep tendon reflexes and how they are graded? Also, watch for Stomach and Right Shoulder Pain (above) and mention this symptom to your health care provider. Literature suggests that the duration of the dorsiflexion around 88.6310.83 ms, and the duration of the plantarflexion 71.756.73 ms. [3] According to the National Institute of Neurological Disorders and Stroke (NINDS) [4], the deep tendon reflexes are graded on a scale from 0 to 4. Copyright 2010 by the American Academy of Family Physicians. Careers. These cells can be found lining the inside of blood vessels throughout the body and organs. Blood pressure is only mildly elevated in 30 to 60 percent of women who develop eclampsia.43 An eclamptic seizure usually lasts from 60 to 90 seconds, during which time the patient is without respiratory effort. This limits their sensitivity in detecting neuropathies of the small nerve fibers (i.e., those with pain, temperature, and autonomic functions). If unresponsive: administer anticonvulsants Do not try to lose weight during pregnancy by restricting your diet. Deep reflexes involve receptor organs 2-12 % severe pre-eclamptic women will develop The benefit of aspirin is greatest (NNT = 19) for prevention of preeclampsia in women at highest risk (previous severe preeclampsia, diabetes, chronic hypertension, renal disease, or autoimmune disease). Complications-abruption, acute renal failure, hepatic hematoma or rupture, pulmonary edema, preterm birth, fetal or maternal death. A deep tendon reflex reflects the function of a part of the nervous system that travels to and from the spinal cord. Damage to the nerves, as in clonus,. Deep reflexes include patellar, Achilles, plantar, triceps, and biceps reflexes. This is where we start to see the signs and symptoms of preeclampsia (they really stem from the damaged endothelial cells). A postictal phase may follow with confusion, agitation, and combativeness. Its a type of hypertensive disorder that occurs during pregnancy. The afferent neuron whose cell body lies in a dorsal root ganglion innervates the muscle or Golgi tendon o Theyre both considered hypertensive disorders BUT gestational hypertension doesnt cause injury to organs in the body or proteinuria, and this leads us to the next criteria. We joined a number of maternal health organizations How to Handle Prenatal and Postpartum Appointments, From Home The disease is sometimes referred to as a silent killer because most people cant feel their blood pressure going up. PMC Normal nerve conduction studies and needle EMG significantly decrease the likelihood of peripheral neuropathy, whereas abnormal nerve conduction findings confirm the diagnosis. Classification Of Hypertensive Disorders Of Pregnancy Nursing Management 1. In non-pregnant normotensive women this was recorded once. During pregnancy, a rise in the lower number (diastolic) of 15 degrees or more, or a rise in the upper number (systolic) of 30 degrees or more can also be a cause for concern. The optimal level of blood pressure control in pregnancies complicated by hypertension is unknown.2,6 Less tight control may decrease the risk that the infant will be small for gestational age, but it may increase the risk of respiratory distress syndrome of the newborn, severe hypertension, and antenatal hospitalization.2,5 Although traditional recommendations are based on diastolic blood pressure, a retrospective review of 28 women with severe preeclampsia who experienced a cerebrovascular accident demonstrated that more than 90 percent had systolic blood pressure over 160 mm Hg, but only 12.5 percent had diastolic blood pressure over 110 mm Hg.45, Intravenous labetalol and hydralazine are commonly used for the acute management of preeclampsia.1,46 A Cochrane review showed no evidence that one parenteral agent had superior effectiveness.46 For women with severe preeclampsia undergoing expectant management remote from term, oral labetalol and nifedipine are acceptable options.7, Fluid Management. This content is owned by the AAFP. Chapter 72. At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. Whether the 1 + and 3 + responses are normal depends on what they were previously, that is, the patient's reflex history; what the other reflexes are; and analysis of associated findings such as muscle tone, muscle strength, or other evidence of disease. While this is not a particularly convenient task, be sure to follow your providers directions and make every effort to be accurate. Preeclampsia and eclampsia nursing maternity NCLEX review for students! Magnesium sulfate is the drug of choice to prevent and treat eclampsia. In disorders that cause acute peripheral neuropathy, such as those produced by toxic exposures, patients may present with similar but more fulminant symptoms, and pain predominates; symptoms also typically have a faster progression. A physical examination may be performed, as well as a test of the deep tendon reflexes. In: StatPearls [Internet]. The https:// ensures that you are connecting to the In: Clinical Methods: The History, Physical, and Laboratory Examinations. Women in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine.7, Morbidity occurs primarily from superimposed preeclampsia or IUGR.4 A sudden increase in blood pressure, new proteinuria, or signs and symptoms of severe preeclampsia indicate superimposed preeclampsia. Additionally, patients begin to experience respiratory paralysis. Share your log with your healthcare provider at each visit and notify her immediately if you find any significant rise between visits. Learning more about the signs and symptoms of preeclampsia, HELLP syndrome and other hypertensive disorders of pregnancy can help you identify a problem early and ensure the best possible outcome. Toxicity can be detected using physical manifestations as a guide. . Several disorders can damage peripheral nerves and cause peripheral neuropathy; it is important to differentiate actual neuropathy from other disorders that can have a similar clinical presentation. Given that preeclampsia is a complex disease, women will develop it for different reasons. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Your healthcare provider will let you know if he/she is concerned and whether it is an indication, along with other signs and symptoms, that you should go to the hospital. Initial evaluation of a patient with peripheral neuropathy should include a complete blood count, comprehensive metabolic profile, and measurement of erythrocyte sedimentation rate and fasting blood glucose, vitamin B. Electrodiagnostic studies are recommended if symptoms persist and if the diagnosis remains unclear after initial diagnostic testing and a careful history and physical examination. By convention the deep tendon reflexes are graded as follows: 0 = no response; always abnormal. The diagnosis requires careful clinical assessment, judicious laboratory testing, and electrodiagnostic studies or nerve biopsy if the diagnosis remains unclear. Reflex Exam (Deep Tendon Reflexes) The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions. Excessive fluid administration can result in pulmonary edema, ascites, and cardiopulmonary overload, whereas too little fluid exacerbates an already constricted intravascular volume and leads to further end-organ ischemia. It is also influenced by the brai a very sensitive test, depends on how performed and your mental state at that time. Bookshelf EMG can detect active axonal damage, as evidenced by the presence of spontaneous muscle fiber activity at rest resulting from the absence of neuro-regulation (denervation). If you've experienced these conditions before pregnancy, be sure to mention them to your care provider during your next visit so they can be monitored closely. Pain in this area should be taken very seriously; do not dismiss it and go to bed. Prevention of injury from seizures, Non-stress test Common vision changes include sensations of flashing lights, auras, light sensitivity, or blurry vision or spots. Some . Classic sign: right upper quadrant pain, also N&V and severe edema, jaundice (look at eyes too for signs of jaundice) Deep tendon reflexes, magnesium, and calcium: assessments and implications The perinatal nurse, in collaboration with physicians, can use deep tendon reflexes as a powerful tool in determining the need to start, adjust, or stop magnesium infusion. Is a change in your deep tendon reflex history an ominous sign?

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