{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T21:09:15Z","timestamp":1764364155782,"version":"3.38.0"},"reference-count":13,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2014,6,1]],"date-time":"2014-06-01T00:00:00Z","timestamp":1401580800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:p> Tetanus is a life-threatening disease that continues to have a high prevalence in developing countries. Severe muscle spasms often require patients to receive tracheostomy, high-dose sedatives, and sometimes prolonged neuromuscular blockade. Magnesium sulfate (MgSO<jats:sub>4<\/jats:sub>) infusion has great promise as an adjunct treatment for severe tetanus, as it may allow clinicians to decrease the dose of other sedative medications. Although the mechanism of action of MgSO<jats:sub>4<\/jats:sub> is not well understood, it appears to attenuate both the muscle spasms and autonomic instability associated with severe tetanus infections. However, MgSO<jats:sub>4<\/jats:sub> infusions are often managed based on serial measurements of serum magnesium levels and other laboratory tests such as arterial blood gases, which can be difficult to obtain in resource-poor settings. We describe a case of severe tetanus in Bhutan managed through the use of magnesium infusion titrated solely to physical examination findings. <\/jats:p>","DOI":"10.1016\/j.wem.2013.11.006","type":"journal-article","created":{"date-parts":[[2014,4,30]],"date-time":"2014-04-30T23:30:20Z","timestamp":1398900620000},"page":"194-197","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Survival of a Patient With Tetanus in Bhutan Using a Magnesium Infusion Managed Only by Clinical Signs"],"prefix":"10.1177","volume":"25","author":[{"given":"Kuenza P.","family":"Wangmo","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margie","family":"Teng","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Henker","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Kinnear","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre, Bedford Park, South Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jampel","family":"Tshering","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2014,6,1]]},"reference":[{"key":"bibr1-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.2002.02698_6.x"},{"key":"bibr2-jwem201311006","first-page":"151","volume-title":"The Global Epidemiology of Infectious Diseases.","author":"Galazka A.","year":"2004"},{"key":"bibr3-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-443-06839-3.00244-7"},{"key":"bibr4-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000162148.03280.02"},{"key":"bibr5-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/87.3.477"},{"key":"bibr6-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000090015.03962.8B"},{"key":"bibr7-jwem201311006","unstructured":"American Academy of Pediatrics. Tetanus (lockjaw). In: Pickering L, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Available at: http:\/\/aapredbook.aappublications.org.laneproxy.stanford.edu\/cgi\/content\/full\/2009\/1\/3.132. Accessed January 17, 2012."},{"key":"bibr8-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-7020-3468-8.50194-2"},{"key":"bibr9-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1378\/chest.92.1.63"},{"key":"bibr10-jwem201311006","unstructured":"Centers for Disease Control and Prevention. Tetanus: Epidemiology and Prevention of Vaccine-Preventable Diseases. Available at: http:\/\/www.cdc.gov\/vaccines\/pubs\/pinkbook\/tetanus.html. Accessed October 26, 2012."},{"key":"bibr11-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/83.2.302"},{"key":"bibr12-jwem201311006","unstructured":"Meier KH. Magnesium. In: Olson KR, ed. Poisoning & Drug Overdose. 6th ed. New York: McGraw-Hill; 2012. Available at: http:\/\/www.accessmedicine.com.laneproxy.stanford.edu\/content.aspx?aID=55978086. Accessed October 26, 2012."},{"key":"bibr13-jwem201311006","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69444-0"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603213003499?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603213003499?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2013.11.006","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1016\/j.wem.2013.11.006","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2013.11.006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T17:38:22Z","timestamp":1741628302000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1016\/j.wem.2013.11.006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,6]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014,6]]}},"alternative-id":["10.1016\/j.wem.2013.11.006"],"URL":"https:\/\/doi.org\/10.1016\/j.wem.2013.11.006","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"type":"print","value":"1080-6032"},{"type":"electronic","value":"1545-1534"}],"subject":[],"published":{"date-parts":[[2014,6]]}}}