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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1742674
Original Article

Safety and Effectiveness of Prolonged Magnesium Sulfate (MgSO4) Infusion for Asthma Exacerbation in Children

Saif Sulaiman Awlad Thani 
1   Section of Pediatric Intensive Care, Child Health Department, The Royal Hospital, Muscat, Oman
,
Atheer Ahmed Alkhan
2   Child Health Department, The Royal Hospital, Muscat, Oman
,
Muzna Yahya Al-Farsi
2   Child Health Department, The Royal Hospital, Muscat, Oman
,
Ahmed Mohammed Al Kamzari
2   Child Health Department, The Royal Hospital, Muscat, Oman
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Abstract

The objective of this study was to assess the safety and describe treatment details of prolonged magnesium sulfate (MgSO4) infusion for children with asthma exacerbation. A retrospective cross-sectional study included children under 13 years of age who were admitted with asthma exacerbation and received at least 24 hours of MgSO4 infusion. One hundred children were included. No patient developed serious adverse events. The mean infusion duration was 74.2 hours. Eighty-nine percent recovered with no other bronchodilator infusions, and 94% did not require respiratory support escalation. Prolonged MgSO4 infusion is safe at a maximum dose of 30 mg/kg/h and may be beneficial for children with asthma exacerbation.

Keywords

magnesium sulfate infusion - asthma exacerbation - safety


Publication History

Received: 06 July 2021

Accepted: 30 December 2021

Article published online:
21 February 2022

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  • References

  • 1 Kokotajlo S, Degnan L, Meyers R, Siu A, Robinson C. Use of intravenous magnesium sulfate for the treatment of an acute asthma exacerbation in pediatric patients. J Pediatr Pharmacol Ther 2014; 19 (02) 91-97
    PubMedGoogle Scholar
  • 2 Özdemir A, Doğruel D. Efficacy of magnesium sulfate treatment in children with acute asthma. Med Princ Pract 2020; 29 (03) 292-298
    CrossrefPubMedGoogle Scholar
  • 3 Stojak BJ, Halajian E, Guthmann RA, Nashelsky J. Intravenous magnesium sulfate for acute asthma exacerbations. Am Fam Physician 2019; 99 (02) 127-128
    PubMedGoogle Scholar
  • 4 Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev 2016; 4 (04) CD011050 . Published 2016 Apr 29. DOI: 10.1002/14651858.CD011050.pub2.
    CrossrefPubMedGoogle Scholar
  • 5 Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. J Aerosol Med 2001; 14 (03) 301-307
    CrossrefPubMedGoogle Scholar
  • 6 Davalos Bichara M, Goldman RD. Magnesium for treatment of asthma in children. Can Fam Physician 2009; 55 (09) 887-889
    PubMedGoogle Scholar
  • 7 Rowe BH, Camargo Jr CA. The role of magnesium sulfate in the acute and chronic management of asthma. Curr Opin Pulm Med 2008; 14 (01) 70-76
    CrossrefPubMedGoogle Scholar
  • 8 Cheuk DKL, Chau TC, Lee SL. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child 2005; 90 (01) 74-77
    CrossrefPubMedGoogle Scholar
  • 9 Song WJ, Chang YS. Magnesium sulfate for acute asthma in adults: a systematic literature review. Asia Pac Allergy 2012; 2 (01) 76-85
    CrossrefPubMedGoogle Scholar
  • 10 Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo Jr CA. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000; (02) CD001490 DOI: 10.1002/14651858.CD001490.
    CrossrefPubMedGoogle Scholar
  • 11 Ciarallo L, Brousseau D, Reinert S. Higher-dose intravenous magnesium therapy for children with moderate to severe acute asthma. Arch Pediatr Adolesc Med 2000; 154 (10) 979-983
    CrossrefPubMedGoogle Scholar
  • 12 Gürkan F, Haspolat K, Boşnak M, Dikici B, Derman O, Ece A. Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy. Eur J Emerg Med 1999; 6 (03) 201-205
    CrossrefPubMedGoogle Scholar
  • 13 Singhi S, Grover S, Bansal A, Chopra K. Randomised comparison of intravenous magnesium sulphate, terbutaline and aminophylline for children with acute severe asthma. Acta Paediatr 2014; 103 (12) 1301-1306
    CrossrefPubMedGoogle Scholar
  • 14 Irazuzta JE, Chiriboga N. Magnesium sulfate infusion for acute asthma in the emergency department. J Pediatr (Rio J) 2017; 93 (Suppl. 01) 19-25
    CrossrefPubMedGoogle Scholar
  • 15 Pabon H, Monem G, Kissoon N. Safety and efficacy of magnesium sulfate infusions in children with status asthmaticus. Pediatr Emerg Care 1994; 10 (04) 200-203
    CrossrefPubMedGoogle Scholar
  • 16 Egelund TA, Wassil SK, Edwards EM, Linden S, Irazuzta JE. High-dose magnesium sulfate infusion protocol for status asthmaticus: a safety and pharmacokinetics cohort study. Intensive Care Med 2013; 39 (01) 117-122
    CrossrefPubMedGoogle Scholar
  • 17 Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor E. An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth 2013; 13 (01) 34
    CrossrefPubMedGoogle Scholar
  • 18 Monem GF, Kissoon N, DeNicola L. Use of magnesium sulfate in asthma in childhood. Pediatr Ann 1996; 25 (03) 136 , 139–144
    CrossrefPubMedGoogle Scholar
  • 19 Glover ML, Machado C, Totapally BR. Magnesium sulfate administered via continuous intravenous infusion in pediatric patients with refractory wheezing. J Crit Care 2002; 17 (04) 255-258
    CrossrefPubMedGoogle Scholar
  • 20 Graff DM, Stevenson MD, Berkenbosch JW. Safety of prolonged magnesium sulfate infusions during treatment for severe pediatric status asthmaticus. Pediatr Pulmonol 2019; 54 (12) 1941-1947
    CrossrefPubMedGoogle Scholar
  • 21 Boeschoten S, de Hoog M, Kneyber M, Merkus P, Boehmer A, Buysse C. Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey. Eur J Pediatr 2020; 179 (03) 455-461
    CrossrefPubMedGoogle Scholar
  • 22 Liu X, Yu T, Rower JE, Campbell SC, Sherwin CMT, Johnson MD. Optimizing the use of intravenous magnesium sulfate for acute asthma treatment in children. Pediatr Pulmonol 2016; 51 (12) 1414-1421
    CrossrefPubMedGoogle Scholar
  • 23 Global Strategy for asthma management and prevention, 2021. Accessed on June, 2021 at: www.ginasthma.org
    PubMedGoogle Scholar
  • 24 Ortiz-Alvarez O, Mikrogianakis A. Canadian Paediatric Society, Acute Care Committee. Managing the paediatric patient with an acute asthma exacerbation. Paediatr Child Health 2012; 17 (05) 251-262
    CrossrefPubMedGoogle Scholar
  • 25 Vaiyani D, Irazuzta JE. Comparison of two high-dose magnesium infusion regimens in the treatment of status asthmaticus. J Pediatr Pharmacol Ther 2016; 21 (03) 233-238
    PubMedGoogle Scholar
  • 26 Irazuzta J, Egelund T, Wassil SK, Hampp C. Feasibility of short-term infusion of magnesium sulfate in pediatric patients with status asthmaticus. J Pediatr Pharmacol Ther 2012; 17 (02) 150-154
    PubMedGoogle Scholar
  • 27 Irazuzta JE, Paredes F, Pavlicich V, Domínguez SL. High-dose magnesium sulfate infusion for severe asthma in the emergency department: efficacy study. Pediatr Crit Care Med 2016; 17 (02) e29-e33
    CrossrefPubMedGoogle Scholar
  • 28 Ducharme FM, Chalut D, Plotnick L. et al. The pediatric respiratory assessment measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr 2008; 152 (04) 476-480 , 480.e1
    CrossrefPubMedGoogle Scholar
  • 29 Dib JG, Engstrom FM, Sisca TS, Tiu RM. Intravenous magnesium sulfate treatment in a child with status asthmaticus. Am J Health Syst Pharm 1999; 56 (10) 997-1000
    CrossrefPubMedGoogle Scholar
  • 30 Hedlin G, Bush A, Lødrup Carlsen K. et al; Problematic Severe Asthma in Childhood Initiative group. Problematic severe asthma in children, not one problem but many: a GA2LEN initiative. Eur Respir J 2010; 36 (01) 196-201
    CrossrefPubMedGoogle Scholar
  • 31 Torres S, Sticco N, Bosch JJ. et al. Effectiveness of magnesium sulfate as initial treatment of acute severe asthma in children, conducted in a tertiary-level university hospital: a randomized, controlled trial. Arch Argent Pediatr 2012; 110 (04) 291-296
    CrossrefPubMedGoogle Scholar
  • 32 Raimondi F, Migliaro F, Capasso L. et al. Intravenous magnesium sulphate vs. inhaled nitric oxide for moderate, persistent pulmonary hypertension of the newborn. A Multicentre, retrospective study. J Trop Pediatr 2008; 54 (03) 196-199
    CrossrefPubMedGoogle Scholar
  • 33 Aali BS, Khazaeli P, Ghasemi F. Ionized and total magnesium concentration in patients with severe preeclampsia-eclampsia undergoing magnesium sulfate therapy. J Obstet Gynaecol Res 2007; 33 (02) 138-143
    CrossrefPubMedGoogle Scholar
  • 34 Ma L, Liu WG, Zhang JM, Chen G, Fan J, Sheng HS. Magnesium sulphate in the management of patients with aneurysmal subarachnoid haemorrhage: a meta-analysis of prospective controlled trials. Brain Inj 2010; 24 (05) 730-735
    CrossrefPubMedGoogle Scholar
  • 35 Natale JE, Guerguerian AM, Joseph JG. et al. Pilot study to determine the hemodynamic safety and feasibility of magnesium sulfate infusion in children with severe traumatic brain injury. Pediatr Crit Care Med 2007; 8 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 36 Busse WW. The relationship of airway hyperresponsiveness and airway inflammation: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010; 138 (Suppl. 02) 4S-10S
    CrossrefPubMedGoogle Scholar
  • 37 Daliparty VM, Manu MK, Mohapatra AK. Serum magnesium levels and its correlation with level of control in patients with asthma: a hospital-based, cross-sectional, prospective study. Lung India 2018; 35 (05) 407-410
    CrossrefPubMedGoogle Scholar
  • 38 Rower JE, Liu X, Yu T, Mundorff M, Sherwin CMT, Johnson MD. Clinical pharmacokinetics of magnesium sulfate in the treatment of children with severe acute asthma. Eur J Clin Pharmacol 2017; 73 (03) 325-331
    CrossrefPubMedGoogle Scholar
  • 39 Lago P, Santana JC, Vivian V, Hypolito E. High-dose prolonged magnesium sulfate infusion in children with severe bronchosapsm: a Brazilian study. Chest 2020; 157 (06) A321 https://journal.chestnet.org/article/S0012-3692(20)31266-6/fulltext#relatedArticles
    CrossrefPubMedGoogle Scholar
  • 40 Scarfone RJ, Loiselle JM, Joffe MD. et al. A randomized trial of magnesium in the emergency department treatment of children with asthma. Ann Emerg Med 2000; 36 (06) 572-578
    CrossrefPubMedGoogle Scholar