Intravenous magnesium sulfate for acute wheezing in young children: a randomised double-blind trial

Abstract

Magnesium sulfate has been shown to be an effective treatment in older children with asthma exacerbations, but it has not been investigated in acute severe virus-induced wheezing in young children.The study enrolled 61 children aged 6 months to 4 years. Inclusion criteria were severe wheezing, classified as a score of ≥6 points as assessed by the Respiratory Distress Assessment Instrument (RDAI) after initial treatment with salbutamol, and the symptoms of acute viral infection. The children were randomly allocated to receive either an infusion of magnesium sulfate (40 mg·kg) or 0.9% sodium chloride as a placebo infusion for 20 min. Primary outcome measure was mean change in RDAI scores from baseline to 6 h after the treatment.Change in the severity of wheezing from baseline to 6 h after the treatment, as measured by mean±sd RDAI scores, was 4.7±2.6 in the magnesium sulfate group and 4.2±4.2 in the placebo group (difference 0.5, 95% CI -1.3 to 2.3, p=0.594).Intravenous magnesium sulfate was ineffective in treating acute severe virus-induced wheezing in young children, in contrast to the previous efficacy demonstrated in older children.

Use of Magnesium Sulfate in Continuous Infusion in Patients With Severe Acute Asthma, in a Pediatric Emergency Room

“…The ideal level of serum magnesium for the treatment of wheezing exacerbations in childhood is not well established in the literature. Several studies have reported achieving therapeutic efficacy with serum concentrations between 3 and 5 mg/dL, corroborating the data found in this study in which the median serum magnesium was 4.3 (3.9-4.6) after 4 hours of infusion (13)(14)(15)(16)(17)(18)(19)(20).…”

“…Magnesium produces smooth muscle relaxation inducing bronchodilation and has a rapid peak of action, but is also rapidly eliminated by the kidney, which restricts its use. In order to prolong the effect of magnesium sulfate, maintaining a compatible therapeutic level to compensate for the rapid elimination, Irazuzta et al suggested the continuous infusion of this medication (16,19,20).…”

“…As a strategy to maintain a consistent therapeutic serum level to compensate for rapid renal elimination, some researchers have proposed the continued use of magnesium sulfate intravenously (14)(15)(16)(17)(18)(19)(20). In a recent study carried out by Irazuzta and collaborators, they demonstrated that the use of magnesium sulfate, at a dose of 50mg/kg/hour for 4 hours when compared to bolus treatment (50mg/kg/hour in 1 hour), had better results in the time of disease progression, improvement in lung function, reduction in the hospitalization rate and a better cost-benefit ratio (17).…”

Eficacia y seguridad de la inmunoterapia subcutánea para alérgenos inhalables en pacientes con alergia respiratoria a un año de tratamiento

“…690 Intravenous magnesium sulfate in a single dose of 40-50 mg/kg (maximum 2 g) by slow infusion (20-60 minutes) has also been used. 691…”

Magnesium sulphate ineffective for viral wheeze in pre‐school‐age children

“…Although strong evidence exists to support the use of intravenous magnesium sulphate in managing exacerbations of asthma in older children, few randomised controlled trials extended eligibility criteria to include those of pre‐school age . A recent single‐centre double‐blind trial randomised 61 children with severe wheezing between 6 months and 4 years of age to either placebo saline or intravenous magnesium sulphate infusion after initial inhaled salbutamol therapy . To be included, children had to score > 5 on the respiratory distress assessment instrument (RDAI), which combines an assessment of both wheeze severity and respiratory effort.…”