Optimizing the use of intravenous magnesium sulfate for acute asthma treatment in children

Abstract

We suggest that optimized dosing regimens could be developed using a linked pharmacokinetic-pharmacodynamic modeling and simulation approach. We propose the factors that should be considered in future clinical trial design in order to better understand the use of IV MgSO in pediatric acute asthma. Pediatr Pulmonol. 2016;51:1414-1421. © 2016 Wiley Periodicals, Inc.

Safety of prolonged magnesium sulfate infusions during treatment for severe pediatric status asthmaticus

“…Hypotensive events were no more likely to occur during infusion initiation/changes as these are times when one would expect the greatest change in serum Mg concentration to occur based on prior pharmacokinetic studies. These studies demonstrated that Mg levels doubled the baseline level at 30 minutes, has a half‐life of approximately 2 hours, and levels were fairly consistent throughout the short (4‐5 hours) infusions . Similarly, our finding that interventions were performed in only a handful of cases (n = 5) supports the conclusion that hypotension, when observed, is deemed to be of limited clinical significance.…”

“…These studies demonstrated that Mg levels doubled the baseline level at 30 minutes, has a half-life of approximately 2 hours, and levels were fairly consistent throughout the short (4-5 hours) infusions. 19,21 Similarly, our finding that interventions were performed in only a handful of cases (n = 5) supports the conclusion that hypotension, when observed, is deemed to be of limited clinical significance. Alternatively, it is possible that diastolic hypotension may have been unrecognized or its clinical significance underestimated by caregivers who may place less confidence in diastolic BP measurements due to decreased accuracy of automated sphygmomanometers at lower BP ranges.…”

Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository

“…11,12 Intravenous magnesium has similarly been shown to have efficacy in pediatric emergency department patients, but there are no randomized controlled trials of magnesium in pediatric inpatients with asthma. [13][14][15][16] In 1 small observational study, use of magnesium in 19 PICU patients with critical asthma was associated with improved respiratory rates. 17 In the United States, magnesium is prescribed to ∼40% of PICU asthma patients, and use within the 8 CPCCRN PICUs ranged from 23% to 64%.…”

The role of magnesium sulfate in the intensive care unit

“…The impact of MgSO 4 on forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) were assessed in different clinical trials (Bessmertny et al, 2002[13]; Bloch et al, 1995[15]; Boonyavorakul et al, 2000[16]; Devi et al, 1997[32]; Gallegos-Solorzano et al, 2010[43]; Green and Rothrock, 1992[51]; Hughes et al, 2003[65]; Mahajan et al, 2004[97]; Silverman et al, 2002[141]; Tiffany et al, 1993[152]). In children, brief infusion and maximum weight-based dosage of MgSO 4 have been suggested for the management of severely ill asthmatic patients in the ICU (Egelund et al, 2013[36]; Liu et al, 2016[94]). Up to 2.5 gram of Mg loading dose with β-agonist and corticosteroid (methylprednisolone, hydrocortisone, and dexamethasone) were reported to be efficacious in the management of asthma (British Thoracic Society Scottish Intercollegiate Guidelines, 2008[20]).…”