Use of Intravenous Magnesium Sulfate for the Treatment of an Acute Asthma Exacerbation in Pediatric Patients

Kokotajlo, Suzannah; Degnan, Lisa; Meyers, Rachel; Siu, Anita; Robinson, Christine

doi:10.5863/1551-6776-19.2.91

Cited by 21 publications

(30 citation statements)

References 13 publications

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“…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 .…”

Section: Therapeutic Index and Cost‐effectivenessmentioning

confidence: 97%

“…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.…”

Section: Muscle Relaxationmentioning

confidence: 99%

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Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

Rebollar

Palacios

Guerrero

et al. 2017

Pediatric Anesthesia

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Magnesium is an essential chemical element in all organisms, intervening in most cellular enzymatic reactions; thus, its importance in homeostasis and as a therapeutic tool in highly challenging patients such as pediatrics. The primary purpose of this paper was to review the role of magnesium sulfate as an adjuvant drug in pediatric anesthesia. This compound already has the scientific backing in certain aspects such as analgesia or muscle relaxation, but only theoretical or empirical backing in others such as organ protection or inflammation, where it seems to be promising. The multitude of potential applications in pediatric anesthesia, its high safety, and low cost make magnesium sulfate could be considered a Super Adjuvant.

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Section: Therapeutic Index and Cost‐effectivenessmentioning

confidence: 97%

Section: Muscle Relaxationmentioning

confidence: 99%

Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

Rebollar

Palacios

Guerrero

et al. 2017

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…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].…”

Section: Magnesium Sulfatementioning

confidence: 99%

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

Kenyon

Auger

Adams

et al. 2014

Curr Treat Options Peds

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Asthma is one of the leading causes of pediatric hospitalization in the USA. This review summarizes evidence-based practices for inpatient pediatric asthma treatment, including routine care, care escalation, and discharge care, along with established and emerging inpatient quality improvement approaches. Intermittent inhaled beta agonists, systemic steroids, and, for patients with low oxygen saturation, supplemental oxygen remain the cornerstones of routine inpatient asthma care. Compared to nebulization, metered-dose inhaler delivery of intermittent beta agonist therapy is more effective and underused. Oral prednisone produces similar clinical outcomes and is more cost-effective when compared with intravenous methylprednisolone. Standardized respiratory assessment scores should supplement clinical judgment in evaluating response to therapy. There are no studies that demonstrate the effectiveness of routine adjuvant anticholinergic therapy outside of the emergency room, though it may be effective in a subset of inpatients. Evidence for inpatient care escalation is limited. With respect to discharge care, simple provision of asthma care plans does not appear to reduce readmissions, though individually tailored asthma care plans remain a standard of discharge care, along with systemic steroids, beta agonists, and, when indicated, inhaled corticosteroids. To avoid medication access barriers for high-risk patients, clinicians can ensure that discharge medications are in-hand before the patient leaves the hospital. A number of quality improvement strategies have shown promise in the inpatient setting. Clinical pathways reduce length of stay and costs associated with care without an associated increase in readmissions. Inpatient family education programs can be effective but should incorporate multiple strategies, including individualized management strategies and post-discharge follow-up. Inpatient care also serves as a useful opportunity to assess home environmental risk and to refer high-risk families to outpatient and community resources.

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“…A single dose of intravenous magnesium sulphate has been shown to be safe and effective in adults and children with acute severe asthma, who have had a poor response to initial therapy 7 . It is a safe drug to administer, but there have been minor side effects reported, such as epigastric or facial warmth, flushing, pain and numbness at the infusion site, dry mouth, malaise, and hypotension 8 . In some cases, severe hypotension may develop.…”

Section: Introductionmentioning

confidence: 99%