Magnesium should be given to all children presenting to hospital with acute severe asthma

Paediatrics: messages from Munich

“…This is in accordance with a very recent systematic review that recommends the use of intravenous magnesium sulfate as a safe and effective adjunct to conventional bronchodilator therapy in children with acute severe asthma [112]. Some researchers even believe that the accumulating evidence confirming a favourable “cost benefit” profile justifies using magnesium for all children presenting with acute severe asthma [113]. …”

Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

“…There were no cases of ‘clinical hypermagnesemia’ related to treatment overdosing (almost exclusively in patients with renal dysfunction). Therefore, MgSO 4 appears to present an optimal safety profile .…”

“…Tracheal intubation (IV) (31) 30 mgÁkg À1 Laryngospasm (IV) (23,33,34) 15 mgÁkg À1 Bronchospasm (IV) (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) 50-100 mgÁkg À1 + 40-50 mgÁkg À1 Áh À1 Bronchospasm (nebulized) (47)(48)(49)(50)(51)(52)(53)(54)(55) 40 mgÁkg À1 or 150 mg (total dose) Antiadrenergic response Cardiopulmonary bypass (IV) (57-60) 25-50 mgÁkg À1 Long QT syndrome (IV) (61) 30-50 mgÁkg À1 + 5-20 mgÁkg À1 Áh À1 Neonatal pulmonary hypertension (IV) (63) 200 mgÁkg À1 + 20-150 mgÁkg À1 Áh À1 Pheocromocytoma (IV) (64) 30-50 mgÁkg À1 + 5-20 mgÁkg À1 Áh À1 Organ protection Neuroprotection (IV) (68-72) 250 mgÁkg À1 Áday À1 Myocardial protection (cardioplegia) (73,74) 40-80 mgÁkg À1 Hypomagnesemia Perioperative hypomagnesemia (IV) (58,59) 25-50 mgÁkg À1 AE 5-20 mgÁkg À1 Áh À1 alveolar concentration by 50% and the induction dose of propofol; it shortens the latency time until a bispectral index value <60 is reached; and it reduces ventilation requirements (tidal volume and respiratory rate) as metabolism decreases (O 2 consumption and CO 2 production) (2,6). Sevoflurane has certain excitatory effects on the central nervous system, which may be associated with increased seizure activity in children.…”

“…Intravenous MgSO 4 (50-100 mgÁkg À1 + 40-50 mgÁkg À1 Áh À1 ) associated with standard treatment-inhaled bronchodilators and systemic corticoids-obtains better results. The best outcomes have been achieved in high severity crisis, early therapy initiation, and with high doses [reducing the needs for ventilatory support, pediatric intensive care unit (PICU) stay, and the costs] (2,(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). It even appears to be more effective and to have fewer side effects than adjuvant IV therapy with aminophylline and terbutaline (46).…”

“…There were no cases of 'clinical hypermagnesemia' related to treatment overdosing (almost exclusively in patients with renal dysfunction). Therefore, MgSO 4 appears to present an optimal safety profile (2,5,(17)(18)(19)(20)31,(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)48,49,59,(68)(69)(70)(71)(72).…”