Randomised trial of magnesium in the treatment of Irukandji syndrome

Abstract

Irukandji syndrome is a distressing condition characterised by pain, hypertension and tachycardia. Some develop cardiac failure and there have been two reported deaths. Magnesium sulphate has become the standard of care despite minimal evidence. The aim of this study was to investigate if magnesium would reduce analgesic requirement and length of stay for patients with Irukandji syndrome. This was a double-blind, randomised controlled clinical trial. Patients with Irukandji syndrome who required parenteral opioid analgesia were randomised to receive either 10 mmol of magnesium as a bolus, and then a 5 mmol/h magnesium infusion for 6 h or saline. Fentanyl patient-controlled analgesia was commenced to allow patients to self-regulate their pain relief. The primary outcome measure of the study was comparison of total analgesic requirements between the two groups. The secondary outcome measure was to compare length of stay. The study ran from November 2003 to May 2007. Thirty-nine patients were enrolled in the study; 26 were male with a median age of 28. Twenty-two received magnesium. There was no significant difference in the morphine equivalent dose used, peak CK, peak troponin, peak pulse, peak blood pressure, peak mean arterial pressure (MAP), percentage MAP rise and length of stay for those receiving magnesium compared with placebo. Our study did not demonstrate a benefit in the use of magnesium in the treatment of Irukandji syndrome. As such the current use of magnesium needs to be reconsidered until there is good evidence to support its use.