High-dose magnesium sulfate infusion protocol for status asthmaticus: a safety and pharmacokinetics cohort study

Abstract

The continuous infusions of MgSO(4) were safe at the studied doses and maintained serum magnesium (SrMg) and ionized magnesium levels similar to levels required to produce smooth muscle relaxation in other clinical settings. Further studies are needed to investigate the efficacy of high-dose continuous MgSO(4) infusion as an adjunctive treatment for severe asthma treatment and determine the SrMg level required to maintain airway smooth muscle relaxation.

High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department

“…Ipratropium bromide was not available in Paraguay during our study, and we cannot speculate about how its coadministration would have altered our findings. Although safety concerns were not a primary endpoint in this study, HDMI was not associated with clinically significant safety concerns, consistent with previous reports (9,10). Furthermore, this experience may not be generalizable to a population suffering from obesity as a comorbidity, a situation that may require adjustment of HDMI dosing.…”

“…Of note, the studied group did not suffer from obesity. HDMI pharmacokinetic have shown magnesium serum levels associated with smooth muscle relaxation but a need of adjustment in patients with obesity (9,10,(26)(27)(28)(29).…”

“…Therefore, the maximum serum level during therapy depends more on the rate of infusion and not on the total dose or duration of the infusion. We have previously determined the feasibility and safety of a high-dose, prolonged magnesium infusion (HDMI) in the PICU for status asthmaticus, producing sustained levels of IoMg associated with smooth muscle relaxation (9)(10)(11).…”

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

“…Magnesium sulfate has been advocated as a coadjuvant treatment when patients do not respond to standard medications. Egelund et al [68] carried out a prospective cohort study within a 20-bed PICU in an academic community hospital. Patients 2-18 years of age admitted with status asthmaticus between October 2009 and August 2010 were included in the study.…”

Improving Asthma Care in the Hospital: an Overview of Treatments and Quality Improvement Interventions for Children Hospitalized for Status Asthmaticus

“…It acts by decreasing intracellular calcium by blocking its entry and release from the endoplasmic reticulum and by activating the sodiumcalcium pumps. A number of studies support the safety of intravenous magnesium as an adjuvant therapy [33,34]; these studies did not include non-ICU inpatient floors. In the emergency room setting, a systematic review and subsequent randomized controlled trial of inhaled magnesium for enhanced bronchodilation demonstrated limited efficacy [35,36], while two metaanalyses have demonstrated more consistent effect of intravenous magnesium in preventing hospital admission [37,38].…”