Prospective study of serum and ionized magnesium pharmacokinetics in the treatment of children with severe acute asthma

Becker, Sarah M.; Job, Kathleen M.; Lima, Kelly M.; Forbes, Ty J.; Wagstaff, Jadon; Tran, Nam K.; Sherwin, Catherine M.T.; Nelson, Douglas S.; Johnson, Michael D.; Rower, Joseph E.

doi:10.1007/s00228-018-2557-7

Cited by 11 publications

(15 citation statements)

References 19 publications

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“…Ionized Mg has the greatest biological activity and is primarily responsible for the smooth muscle relaxation desired during use in the treatment of status asthmaticus. However, studies have demonstrated that ionized Mg concentrations strongly correlated with serum Mg concentrations . Due to availability, we currently only measure total serum levels as do most institutions and data is limited using ionized Mg levels to titrate drips.…”

Section: Discussionmentioning

confidence: 99%

“…Incidents of hypotension were considered associated with either the initiation of or change in the Mg infusion rate, or a supratherapeutic Mg level if they occurred within 120 minutes of these events. The post infusion time frame chosen was longer than prior studies, which monitored for 20 to 30 minutes based on prior pharmacokinetics studies, in hopes of identifying any potentially delayed adverse events. Fluid boluses not given for overt hypotension were not considered adverse events, per se.…”

Section: Methodsmentioning

confidence: 99%

“…However, studies have demonstrated that ionized Mg concentrations strongly correlated with serum Mg concentrations. 16,21 Due to availability, we currently only measure total serum levels as do most institutions and data is limited using ionized Mg levels to titrate drips. Further research is required regarding this subject.…”

Section: Cardiovascular Depression Remains the Largest Clinical Concernmentioning

confidence: 99%

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

Graff

Stevenson

Berkenbosch

2019

Pediatric Pulmonology

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Objective Magnesium sulfate (Mg) is one of several “second‐tier” therapies for treating severe status asthmaticus. Pediatric reports primarily describe bolus use with limited data regarding prolonged infusions. We sought to describe the safety of prolonged Mg infusions during therapy of status asthmaticus in critically ill children. Design Single center, retrospective study. Setting Thirty‐four‐bed tertiary level medical/surgical/cardiac surgical pediatric intensive care unit. Patients Pediatric patients 2 to 18 years of age admitted with status asthmaticus receiving Mg infusion for more than 24 hours. Interventions None. Measurements and main findings A total of 154 children received Mg infusions for a median of 53.4 hours (interquartile range = 36.6‐74.8). The most common adverse event (AE) was hypotension (48.1%), almost exclusively diastolic (94%), and was mostly limited to 1 blood pressure measurement (78%). 2.9% of events required intervention (fluids, decrease Mg infusion). Other AEs included nausea/emesis (22.7%), transient weakness (14.9%), and flushing (6.5%). Five patients experienced serious AEs including hypotonia (n = 1), escalation to continuous or bilevel positive airway pressure (n = 3), and sedation (n = 1), all attributed to progression of underlying medical disease. No patient required endotracheal intubation. Supratherapeutic levels (>6 mg/dL) were uncommon (2%) and were not more likely to be associated with AEs. Most (81%) patients were therapeutic by the 2nd Mg level check. Conclusion Prolonged Mg infusions were well tolerated in pediatric status asthmaticus patients. While diastolic hypotension was not uncommon, rarely were interventions deemed necessary. No serious AEs were attributed to Mg. Toxicity was uncommon suggesting that Mg levels could potentially be checked less frequently than historically reported.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Cardiovascular Depression Remains the Largest Clinical Concernmentioning

confidence: 99%

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

Graff

Stevenson

Berkenbosch

2019

Pediatric Pulmonology

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“…Garam mandi (61)(62)(63)(64) Kapasitas Kalor (72)(73)(74)(75) Sintesis organik (16; 76-78) Pengering (34)(35)(36)(37) Pertanian (38)(39)(40) Farmasi (18)(19)(20)(21) Elektrolit pada sintesis (85)(86)(87) Koagulan (31)(32)(33) Mobilitas Ion (65)(66)(67) Bentuk dan struktur (11; 46; 80; 81) MgSO4 umumnya dapat dijumpai dalam garam epsomite yakni MgSO4.7H2O. Di alam senyawa ini terdapat dalam bentuk mineral sulfat.…”

Section: Sifat Fisikaunclassified

Analisis Termodinamika Molekul Magnesium Sulphate (MgSO4)

Yuliani¹,

Zainul²

2018

Preprint

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Magnesium sulfat merupakan salah satu garam anorganik dengan rumus kimia MgSO4. Magnesium sulfat ini termasuk senyawa ionik karena terdapat ikatan antara logam magnesium dengan spesi non logam sulfat. Magnesium sulfat bersifat polar, bentuk anhidratnya sangat higroskopik dan mudah memiliki koordinasi dengan air. Umumnya magnesium sulfat terbentuk dalam formasi hidrat MgSO4.xH2O. Penelitian ini bertujuan untuk menganalisis pengaruh sifat termodinamika molekul MgSO4 terhadap interaksi molekuler di dalam senyawa tersebut. Metode yang digunakan ialah pemodelan dengan aplikasi ChemOffice 15.0. Sedangkan untuk data mobilitas ion, konduktivitas, viskositas, kecepatan hanyut dengan menggunakan perhitungan dan data dari hasil review beberapa jurnal penelitian yang berkaitan dengan magnesium sulfat sesuai tahapan yang tertera pada fishbond. Magnesium sulfat memiliki sifat termokimia dalam fasa solid dengan ∆𝐻𝑓,∆𝐺𝑓,𝑆°, 𝑑𝑎𝑛 𝐶𝑝 pada tekanan 1 atm dan suhu 25°C yang masing-masing mempunyai nilai -1284,9 kJ/mol, -1170,7 kJ/mol, 91,6 J/molK dan 96,48 J/molK. Mobilitas ion Mg2+dan SO42- adalah 5,50.10-8m2s-1V-1 dan 8,29.108m2s-1V-1. Panas reaksi standar (ΔHr°) MgSO4 bernilai negatif maka reaksi bersifat eksotermis

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“…Magnesium is considered a calcium channel blocker, both centrally blocking Ca 2+ at NMDA receptors in the CNS and in peripheral vessels (2). MgSO 4 is commonly used in humans for the treatment of preeclampsia in women (3–5), post stroke prevention of hypoxia induced glutamate excitotoxicity (6), the perioperative management of pheochromocytomas (7), and the treatment of acute asthma (8–10). In horses, MgSO 4 is used to treat large colon impactions (11, 12) and there has been recent investigation into its use for the treatment of trigeminal neuritis (13).…”

Section: Introductionmentioning

confidence: 99%

Radio-Telemetric Assessment of Cardiac Variables and Locomotion With Experimentally Induced Hypermagnesemia in Horses Using Chronically Implanted Catheters

et al. 2019

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The objective of this study was to characterize the pharmacokinetics and pharmacodynamics of intravenous administration of magnesium sulfate to horses using a novel radio-telemetry system for physiologic signal capture. Five Horses were surgically implanted with a radio-telemetric carotid catheter. Implants were paired with a non-invasive telemetric unit which acquired a six lead ECG and 3-axis acceleration to assess activity acquired wirelessly in real-time for future analysis. Horses were exposed to a new stall environment before (baseline) and after 60 mg/kg (30 mL) of magnesium sulfate (MgSO4), or the same volume of 0.9% saline, administered intravenously in a blinded, random crossover design. Blood for pharmacokinetics, telemetric data, and body temperature were recorded serially for 24 h. Data were analyzed across time and between treatments. Significance was set at P < 0.05. Ionized magnesium concentration (Mg2+) increased and the Ca2+ to Mg2+ ratio decreased and persisted for 5 h after MgSO4 administration. Heart rate (HR) increased and mean arterial blood pressure (MAP) decreased for at least 6 h. Electrocardiogram (ECG) intervals (RR) decreased and (PR and QTc) increased in duration compared to controls indicating an increase in heart rate, and slower myocardial conduction in the MgSO4 group. Acceleration in all planes was less in the MgSO4 group compared to controls indicating decreased locomotion. This novel method permitted collection of physiologic signals without interference by handlers or animal restraint. An intravenous bolus of MgSO4 produced cardiac variable changes associated with the reduction of locomotion in these horses, and in a direction that may be causal. Locomotion was decreased when horses were first introduced into a new environment which reflects the calming effect desired in sport horses. Telemetric monitoring can be used as a model to elucidate the behavior and physiologic effects of other drugs. The administration of MgSO4 may be detected for regulatory purposes with the monitoring of Mg2+ and Ca2+ concentrations and their ratio.

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Prospective study of serum and ionized magnesium pharmacokinetics in the treatment of children with severe acute asthma

Cited by 11 publications

References 19 publications

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

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

Analisis Termodinamika Molekul Magnesium Sulphate (MgSO4)

Radio-Telemetric Assessment of Cardiac Variables and Locomotion With Experimentally Induced Hypermagnesemia in Horses Using Chronically Implanted Catheters

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