Isotonic Magnesium Sulfate Research Articles

Value of Adding Nebulized Magnesium Sulphate to Rescue Medications in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients Admitted to Emergency Room

Abstract Introduction Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases, Nebulized magnesium is attractive as a therapeutic option because it is easily administered, relatively cheap and has minimal side effects. In light of some evidence for an effect when nebulized in severe exacerbations of asthma, the similarities between asthma and chronic obstructive pulmonary disease (COPD) (especially with regard to bronchodilator therapy) and the practical advantages of administration via nebuliser, we sought to focus on the nebulized route of delivery in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Objective The aim of this work was to evaluate the effect of administration of nebulized magnesium sulphate in the management of acute exacerbations of chronic obstructive pulmonary disease. Patient and methods The study was conducted upon 100 patients with acute exacerbation of COPD randomly divided into two groups, 50 patients for each group who admitted to emergency room with acute exacerbation of Chronic Obstructive Pulmonary Disease in Mansoura chest diseases hospital From January 2019 to June 2019, All patients randomly divided into two groups, Patients of group A: included 50 patients received 2.5 mg salbutamol (2.5 ml), mixed with 500 mg isotonic magnesium sulphate(5 ml), Patients of group B: included 50 patients received 2.5 mg salbutamol mixed with 2.5 ml isotonic saline. Treatment for all patients were given via nebulizer. Results There were no significant differences between group I who received nebulized magnesium sulphate + salbutamol and group II who received nebulized salbutamol regarding pulmonary functions (FEV1, FVC and FEV1/FVC), before and after treatment. After treatment there is a significant increase in O2 saturation, PO2 and Serum Mg(more in group I who received nebulized magnesium sulphate + salbutamol than group II who received nebulized salbutamol) and no significant difference between the two groups as regard PH, PCO2, HCO3, and CRP. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, and O2 Saturation after treatment and no significant change in PH, PCO2, HCO3, serum Mg and CRP, in patients received salbutamol nebulizer. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, O2 Saturation and serum Mg after treatment and no significant change in PH, PCO2, HCO3, and CRP in patients received Magnesium sulphate + salbutamol nebulizer. Conclusion Adding nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1, FVC&FEV1/FVC. Nebulized magnesium sulphate+ salbutamol provides nearly equal response to nebulized salbutamol in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in adults. So we do not recommend routine using of nebulizeld magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD.

Effect of Addition of Nebulized Magnesium Sulphate to Standard Therapy in Children with Severe Asthma

 Objective: To compare the outcome of addition of nebulized magnesium sulphate to the standard treatment in children with acute severe asthma. Methodology: The trial was undertaken at the emergency of Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019.Children between 1 to 12 years of age with acute severe asthma were initially nebulized with salbutamol thrice and ipratropium once.All the patients were also given intravenous steroid.Those not responding to this treatment and still classified as acute severe asthma were randomly divided into two groups each having 38 patients.Each patient in Group A received 2.5 ml (150 mg) of isotonic magnesium sulphate via nebulizer, thrice20 minutes apart, while group B received 2.5 ml of isotonic saline via nebulizer, thrice20 minutes apart.Each nebulization also contained salbutamol. Yung Asthma Severity Score (ASS) was determined at the start of treatment, at30 minutes and at 60 minutes of treatment. Results: After 60 minutes, the mean Asthma Severity Score of children in group A was 6.95 ± 1.29 and 7.63 ± 1.03 in group B (p < 0.05). In group A, 18 (47.4%) children were discharged and 20 (52.6%) were admitted in the hospital. In group B, 7 (18.4%) children were discharged while 31 (81.6%) were admitted in the hospital (p < 0.05). Conclusion: It is concluded that nebulized magnesium sulphate along with salbutamol can give a better outcome than salbutamol alone in children with acute severe asthma.

Nebulized Magnesium Sulphate vs Normal Saline as an Adjunct in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Magnesium revealed to have properties of bronchodilation in chronic obstructive pulmonary disease (COPD) and asthma. A clinical benefit of nebulization with magnesium has been observed in asthma. The aim of the analysis was the therapeutic benefits comparison of using magnesium sulphate in nebulized form as an adjuvant of the normal saline solution among patients with exacerbations of COPD. Study Design: A randomized single blind interventional study. Place and Duration: In the Department of Medicine, Islam Medical College and Teaching Hospital Sialkot for six months duration from March 2021 to September 2021 Methods: This study involved 132 cases of acute COPD exacerbations with PEFR <300 L / min, evaluated twenty mints after initial therapy. Patients were administered salbutamol 5mg mixed with 3 ml of saline or 3 ml of isotonic magnesium sulphate three times at thirty-minute intervals using a nebulizer. At 90 minutes: Primary outcome of PEFR were measured and admission to hospital, invasive or non-invasive ventilation along with mortality were measured as 2ndry outcomes. Results: After nebulization with magnesium sulphate, the mean PEFR was 86.3 ± 11.9 l / min, 97.6 ± 19.1 l / min and 99.6 ± 15.2 l / min and 79.17 ± 14.11 l / min, 90.17 ± 18.27 l / min, and 93.17. ± 20.63 L. Statistically significant differences were found in the normal saline group at thirty, sixty and ninety minutes, correspondingly. In the magnesium group, 91.9% were admitted to the ward, 8.1% to the intensive care unit, 81.7% to the ward, and 18.3% to the salt group to the intensive care unit. The differences in ventilation and mortality were negligible. Conclusions: In the context of AECOPD, nebulized magnesium sulphate in combination with salbutamol has a therapeutic advantage over PEFR, but has no effect on hospitalization, the need for mortality and non-invasive or invasive ventilation. Keywords: Peak expiratory flow, magnesium sulphate and chronic obstructive pulmonary disease.

Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study

Introduction Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation.
 MethodsIt was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes.
 ResultsThe mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant.
 ConclusionNebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality.

Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study

Introduction: Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation. Methods: It was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes. Results: The mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant. Conclusion: Nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality.

The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment

BackgroundAfter the bronchodilator effect of magnesium was shown, the use of magnesium in treatment of asthma exacerbations became common. With the results of recent studies, the use of intravenous magnesium in severe asthma exacerbations took its place. We aimed to examine the effects of adding isotonic magnesium sulphate instead of isotonic saline into nebulised salbutamol on the Modified Pulmonary Index Score (MPIS) and the hospitalisation rate in moderate asthma exacerbations. MethodsOur study population included 100 children age between 3 and 15 years with asthma admitted to emergency department due to moderate asthma exacerbations. The patients were randomised to placebo or magnesium, with 50 patients in each arm. All patients received 1mg/kg of systemic methylprednisolone at the beginning of treatment and thereafter received either nebulised salbutamol (0.15mg/kg/dose) and 1ml magnesium sulphate (15%)+1.5ml isotonic saline on three occasions at roughly 20min intervals (Magnesium group) or nebulised salbutamol (0.15mg/kg/dose) and 2.5ml isotonic saline mixture on three occasions at roughly 20min intervals (Placebo group). The MPIS of patients on 0th min, 20th min, 40th and 120th min were calculated and compared. The primary outcome was to compare MPIS values at the end of 120th min. ResultsBoth groups have similar demographic, allergic characteristics and baseline MPIS scores. When the MPIS scores in the 120th min and admission rates in the 200th min, there was no significant difference between the two groups. ConclusionsThe use of nebulised magnesium sulphate in moderate asthma exacerbation as adjuvant treatment showed no benefit to standard treatment in our study.

Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children.

Asthma attacks are serious respiratory problem that can be lethal when not treated appropriately. Till today the main stay of therapy is short acting ß2-agonist. Unfortunately in acute asthma episodes this is not enough to relieve the bronchospasm and reduce dyspnea. The shortcoming of ß2-agonist therapy has resulted in the use of a variety of other treatment in the management of acute asthma. The use of magnesium sulphate is one of the recent treatment options. This study was done to compare the efficacy of nebulized salbutamol with magnesium sulphate versus salbutamol with normal saline in the treatment of acute exacerbation of asthma in children. This randomized controlled trial was carried out among 60 patients with acute exacerbation of bronchial asthma fulfilling the inclusion criteria, admitted in the department of Paediatrics, Mymensingh Medical College Hospital over a period of one year from January 2009 to December 2009. They were distributed randomly, 30 patients received nebulized salbutamol (0.15mg/kg; minimum dose 2.5mg) with 2.0 ml of isotonic magnesium sulphate solution and another 30 patients received the same dose of salbutamol with 2.0 ml of normal saline on 3 occasions at 20 minute intervals. With single dose of nebulization in the magnesium sulphate with salbutamol group, by 20 minute almost all 26 (86.7%) patients achieved at least 60% of predicted PEFR. Within 20 minute from control group none could achieve 60% of predicted PEFR. After second dose of nebulization control group started achieving 60% of predicted value. Regarding response criteria, with second dose of nebulization, at 40 minute 16 (53.3%) patient from magnesium sulphate with salbutamol group showed good response (PEFR>70% predicted). But within the first 40 minutes, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulphate group showed good response but even at 60 minute, 5 (16.7%) patients in control group failed to be included as good responder. In conclusion, nebulization by isotonic magnesium sulphate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.Faridpur Med. Coll. J. 2014;9(2): 61-67

TRPA1, NMDA receptors and nitric oxide mediate mechanical hyperalgesia induced by local injection of magnesium sulfate into the rat hind paw

Previous studies have shown that while magnesium, an antagonist of the glutamate subtype of N-methyl-D-aspartate receptors, possesses analgesic properties, it can induce writhing in rodents. The aim of this study was to determine the effect and mechanism of action of local (intraplantar) administration of magnesium sulfate (MS) on the paw withdrawal threshold (PWT) to mechanical stimuli. The PWT was evaluated by the electronic von Frey test in male Wistar rats. Tested drugs were either co-administered intraplantarly (i.pl.) with MS or given into the contralateral paw to exclude systemic effects. MS at doses of 0.5, 1.5, 3 and 6.2mg/paw (i.pl.) induced a statistically significant (as compared to 0.9% NaCl) and dose-dependent mechanical hyperalgesia. Only isotonic MS (250mmol/l or 6.2% or 6.2mg/paw) induced mechanical hyperalgesia that lasted at least six hours. Isotonic MS-induced mechanical hyperalgesia was reduced in a dose-dependent manner by co-injection of camphor, a non-selective TRPA1 antagonist (0.3, 1 and 2.5μg/paw), MK-801, a NMDA receptor antagonist (0.001, 0.025 and 0.1μg/paw), L-NAME, a non-selective nitric oxide (NO) synthase inhibitor (20, 50 and 100μg/paw), ARL 17477, a selective neuronal NOS inhibitor (5.7 and 17μg/paw), SMT, a selective inducible NOS inhibitor (1 and 2.78μg/paw), and methylene blue, a guanylate cyclase inhibitor (5, 20 and 125μg/paw). Drugs injected into the contralateral hind paw did not produce significant effects. These results suggest that an i.pl. injection of MS produces local peripheral mechanical hyperalgesia via activation of peripheral TRPA1 and NMDA receptors and peripheral production of NO.

Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial

BackgroundIntravenous magnesium has been shown to cause bronchodilation in acute severe asthma and in small trials in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is also some evidence...

Analgesic effect of intra-articular magnesium sulphate compared with bupivacaine after knee arthroscopic menisectomy

This work aimed to evaluate the analgesic efficacy of intra-articular injection of magnesium sulphate (4%) compared with equivalent volume of bupivacaine (0.5%) after outpatient knee arthroscopic meniscectomy. Forty patients were randomly assigned to two groups. Group M (n=20) received intra-articular magnesium sulphate 4%, group B (n=20) received bupivacaine (0.5%). Analgesic effect was evaluated by analgesic duration, and by measuring pain intensity at 1, 2, 4, 6, 12, 24h both at rest and on knee movement to 90°. The primary outcome variable was pain intensity on the VAS at 1, 2, 4, 6, 12, 24h post arthroscopy at rest and on movement (flexion of knee to 90°), although the magnesium group had lower time weighted averages (TWAs) at rest and on movement, these TWAs were not statistically significant. The median duration of postoperative analgesia was significantly longer in the patients treated with magnesium sulphate (528min) than in the bupivacaine group (317min) (p<0.0001), with less number of patients needing supplementary analgesia in magnesium group (8/20) than those of the bupivacaine group (16/20) (p<0.022). Also analgesic consumption was significantly lower in the magnesium sulphate group (p<0.002). We concluded that the use of magnesium sulphate is rational and effective in reducing pain, and is more physiological and shortens convalescence after outpatient arthroscopic meniscectomy, however our hypotheses that analgesic efficacy of intra-articular isotonic magnesium sulphate would be superior to intra-articular local anaesthetic cannot be supported with this study.

Efficacy of nebulized magnesium sulfate in the treatment of acute exacerbation of asthma in children

A double-blind randomized controlled trial was conducted to examine the efficacy of nebulized magnesium sulfate in the treatment of acute exacer-bation of asthma in children. Thirty patients received nebulized salbutamol (0.15 mg/kg; minimum dose 2.5 mg) with 2.0 mL of isotonic magnesium sulfate solution and another 30 patients received same dose of salbutamol with 2.0 mL of normal saline on 3 occasions at 20 min intervals. Mean percent of predicted peak expiratory flow rate (PEFR) detected in both group at 0 min were not significantly different. But from 10 min up to 60 min, the values were significantly different among the groups. Mean respiratory rate at 0 and 10 min were similar in both groups and from 20 up to 60 min, respiratory rate improvement were significantly different. Arterial oxygen saturation (SaO2) at presentation was not significantly different. But from 10 min up to 60 min differences were significant. With single dose of nebulization, in the magnesium sulfate with salbutamol group, by 20 min almost all (29 out of 30) patient achieved at least 60% of predicted PEFR. Within this 20 min, from control group none could achieve 60% of predicted PEFR. After 2nd dose of nebulization control group started achieving 60% PEFR value. Regarding response criteria, with 2nd dose of nebulization, at 30 and 40 min 9 (30.0%) and 17 (56.7%) patient from magnesium sulfate with salbutamol group showed good response (PEFR ≥70% predicted). But within this first 40 min time, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulfate group showed good response but even at 60 min, 4 (13.3%) patient in control group failed to be included as good responder. So, it is evident that nebulization by isotonic magnesium sulfate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.

Comparison of different vehicles for nebulized salbutamol in treatment of bronchial asthma exacerbations: a Meta-analysis

To assess the efficacy of two vehicles for nebulized salbutamol in treatment of asthma exacerbations with Meta-analysis. All relevant randomized controlled clinical trials (RCT) with isotonic magnesium sulphate and saline as vehicles for inhaled salbutamol in treatment of asthma exacerbations were searched. A Meta-analysis was performed to evaluate the results of the two therapies. Five relevant RCTs from literature were collected and total 219 cases were included for analysis. The meta-analysis indicated that the significant improvements were obtained from isotonic magnesium sulphate as a vehicle for nebulized salbutamol, in comparison with saline [pooled standardized mean difference (SMD)=0.55(95% CI 0.28 - 0.83), P <0.001]. By further subgroup analysis, this change was properly significant in the subgroup of severe patients with their baseline FEV1% <30% [FEV1 weighted mean difference (WMD)=0.72 L(95% CI 0.30 L - 1.14 L), P <0.01]. The pooled results of vital signs between two vehicles did not demonstrate statistical significance. Overall, the risk of admission to hospital was not statistically reduced in patients using magnesium sulphate, who presented to the emergency department with an asthma exacerbation [pooled RR=0.64(95% CI 0.38 - 1.08), P >0.05]. Compared with saline,the use of isotonic magnesium sulfate as an adjuvant to nebulize salbutamol is a beneficial therapy with improving spirometric airway function in the severe asthma exacerbation.

Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial

Intravenous magnesium can cause bronchodilation in treatment of severe asthma, however its effect by the nebulised route is uncertain. We aimed to assess the effectiveness of isotonic magnesium sulphate as an adjuvant to nebulised salbutamol in severe attacks of asthma. We enrolled 52 patients with severe exacerbations of asthma presenting to the emergency departments at two hospitals in New Zealand. A severe exacerbation was defined as a forced expiratory volume at 1 s (FEV(1)) of less than 50% predicted 30 min after initial administration of 2.5 mg salbutamol via nebulisation. In this randomised double-blind placebo-controlled trial patients received 2.5 mg nebulised salbutamol mixed with either 2.5 mL isotonic magnesium sulphate or isotonic saline on three occasions at 30 min intervals. The primary outcome measure was FEV(1) at 90 min. Analysis was per protocol. At 90 min the mean FEV1 in the magnesium group was 1.96 L (95% CI 1.68-2.24) and in the saline group 1.55 L (1.24-1.87). The difference in the mean FEV(1) between the magnesium and saline groups was 0.37 L (0.13-0.61, p=0.003). Use of isotonic magnesium as an adjuvant to nebulised salbutamol results in an enhanced bronchodilator response in treatment of severe asthma.

Magnesium sulfate as a vehicle for nebulized salbutamol in acute asthma

Purpose: Magnesium sulfate is thought to be an effective bronchodilator when administered intravenously to patients with acute severe asthma, and it can be safely administered via inhalation to patients with stable asthma. Our goal was to determine if isotonic magnesium sulfate could be used as a vehicle for nebulized salbutamol for patients with acute asthma. Methods: We enrolled 35 patients with acute asthma in a randomized, double-blind, controlled trial. After measurement of peak expiratory flow, patients received 2.5 mg salbutamol plus either 3 mL normal saline solution (n = 16) or isotonic magnesium sulfate (n = 19) through a jet nebulizer. Peak flow was reassessed 10 and 20 minutes after treatment. Results: Peak flow at baseline was similar in the two groups. Ten minutes after baseline, the mean (± SD) percentage increase in peak flow was greater in the magnesium sulfate-salbutamol group (61% ± 45%) than in the normal saline-salbutamol group (31% ± 28%; difference = 30%; 95% confidence interval [CI] for the difference: 3% to 56%; P = 0.03). At 20 minutes, the percentage increase in peak flow was 57% greater in the magnesium sulfate group (95% CI: 4% to 110%, P = 0.04). There was a significant inverse correlation between baseline peak flow (percent of predicted) and the percentage increase in peak flow at 20 minutes in the magnesium sulfate group ( r = −0.82, P <0.0001), but not in the saline group ( r = −0.12, P = 0.67). Conclusion: In patients with acute asthma, isotonic magnesium sulfate, as a vehicle for nebulized salbutamol, increased the peak flow response to treatment in comparison with salbutamol plus normal saline.

Prevention of thrombosis in microvascular surgery by the use of magnesium sulphate

Summary A new technique has been developed for the prevention of thrombosis at suture anastomoses in small blood vessels. The technique consists of irrigating the outside of the anastomosed vessel with isotonic magnesium sulphate solution throughout the first 20 minutes of blood flow. Use of this technique gave 90 per cent success in end-to-end anastomosis of arteries 0·5 mm. in diameter. A description of the technique is preceded by an account of the behaviour of platelet thrombi at sites of surgical injury, and a brief account of the physiology of platelets.

Effect of Anemic Anoxia on Absorption of Isotonic Magnesium Sulfate from the Small Intestine.

SummaryThe rate of absorption of magnesium sulfate was studied in a series of barbitalized dogs each of which had suffered a hemorrhage equal to 3% of its body weight. The control animals absorbed 14% of the magnesium and 13% of the sulfate, whereas the experimental animals absorbed 17% and 16% respectively. The differences were not statistically significant. A fact not sufficiently appreciated is that the intestine is only relatively impermeable to this salt.