A 22-Year-Old Primigravida at 34 Weeks Gestation Is Brought to the Emergency

A 22-year-old primigravida at 34 weeks gestation is brought to the emergency department by ambulance due to sudden loss of consciousness followed by generalized shaking.  The paramedics initiated an intravenous magnesium sulfate bolus, which was infusing rapidly when the patient arrived at the hospital.  She says she is very tired and has blurry vision and a headache.  The patient also has muscle pain and sore joints and is unable to move her right arm.  Blood pressure is 145/98 mm Hg, pulse is 112/min, and respirations are 16/min.  She holds the right arm adducted and internally rotated.  Examination shows loss of external rotation of the right arm but no sensory deficits.  Deep tendon reflexes are 2+ bilaterally, and handgrip and wrist strength are preserved on both sides.  Urinalysis shows 3+ protein.  Which of the following is the most likely cause of this patient's right arm findings?

A) Anterior shoulder dislocation
B) Magnesium toxicity
C) Posterior shoulder dislocation
D) Postictal (Todd) paralysis
E) Radial nerve compression

Correct Answer:

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