Use Of Intravenous Magnesium Sulfate Research Articles

Effectiveness of Intravenous Magnesium Sulfate in Children Presenting to the Emergency Department with Acute Exacerbation of Asthma

Asthma is a serious medical condition in the pediatric age group and can have a high mortality, therefore it should be managed effectively. Patients not responding adequately to first line therapy need additional treatment. A few research studies have evaluated the use of intravenous magnesium sulfate in improving respiratory scores in severe acute pediatric asthma but the results have been conflicting. Objectives: To determine the benefit of intravenous magnesium sulfate in treating children presenting with worsening of asthma symptoms. Methods: A cross-sectional prospective study carried out at the Pediatrics Unit of Zia Uddin University Hospital, Karachi from 1st March 2021 to 1st March 2022. On the whole, 280 children in the age group 2-12 years with acute worsening of asthma of were selected by non-probability purposive sampling technique, however, children in need of invasive ventilation and those having asthma related complications on radiological investigations were omitted. Chi-square was applied for categorical variables and a p-value <0.05 was considered statistically significant. Results: Out of 280 patients who came to the Pediatric Emergency Department with acute severe asthma, 236 (84.3%) patients responded to a single dose of intravenous magnesium sulfate manifested by an improvement in clinical asthma score, while 44 patients (15.7%) did not show improvement. The admission rate to the pediatric intensive care unit was only 12.8%. Conclusion: Magnesium sulfate infusion helps improve respiratory symptoms in acute worsening of pediatric asthma.

Reply to: Magnesium sulphate intravenously reduces tachycardia side-effects of β2-agonists

Intravenous magnesium sulphate reduces β2-agonist induced tachycardia https://bit.ly/3pPnGKl.

A High-Value Care Initiative to Reduce the Use of Intravenous Magnesium Sulfate Through an Electronic Indication-Based Order Set.

Intravenous (IV) magnesium sulfate (MgSO4) supplementation is common despite limited indications. Oral magnesium oxide (MgO) is an effective, lower-cost alternative. This project aimed to reduce IV MgSO4 use by 20% among the Internal Medicine (IM) service. Electronic health record (EHR) orders for MgSO4 and MgO within the IM service were replaced with an indication-based EHR order panel. The project team educated clinicians regarding indications for IV MgSO4 and relative costs. The mean of daily 2 g MgSO4 administrations per week and the mean of weekly proportion of 2 g MgSO4 administrations nine months before and after intervention were compared between IM and Emergency Medicine (EM) (control group). Statistical process control analysis was used to assess for special cause variation in daily MgSO4 per week and weekly proportion of MgSO4 administrations. The mean of daily 2 g IV MgSO4 administrations per week decreased among IM (19.3 vs. 12.1, p < 0.0001) but not EM (3.1 vs. 4.8, p < 0.0001). The mean of weekly proportions of IV MgSO4 administrations decreased among both IM (83.6% vs. 60.7%, p < 0.0001) and EM (97.0% vs. 93.1%, p = 0.0004). For IM, the change in daily MgSO4 per week and weekly proportion of MgSO4 occurred as a discrete initial decline consistent with special cause variation; for EM, changes in both measures were not consistent with special cause variation. Replacing stand-alone IV MgSO4 orders with an indication-based order panel along with clinician education reduced IV MgSO4 administrations and may offer a significant opportunity to reduce low-value care.

Use of magnesium sulfate in continuous infusion in patients with severe acute asthma, in a pediatric emergency room.

Asthma is a chronic disease, of high prevalence, with important morbidity and that can lead to death in childhood. The use of intravenous magnesium sulfate has been indicated in cases refractory to the initial management with inhaled bronchodilators and corticosteroids. To evaluate the use of magnesium sulfate in continuous infusion (50 mg/kg/h in 4 h) in children with severe acute asthma in a pediatric emergency room. Ten-bed general pediatric emergency room, university hospital, tertiary, in southern Brazil. All children over 2 years old with severe acute asthma refractory to the initial treatment who received a continuous infusion of magnesium sulfate at a dose of 50 mg/kg/h in 4 h, from April 2017 to October 2019. Based on this study, the use of continuous intravenous magnesium sulfate proved to be well tolerated, leading to improved respiratory status, and can be considered as a satisfactory adjunctive therapy in the management of severe acute asthma.

The cost-utility of intravenous magnesium sulfate for treating asthma exacerbations in children.

Although evidence supports the use of intravenous magnesium sulfate (MS) in asthma exacerbations, MS continues to be considered a second-line drug for managing pediatric asthma exacerbations. This study aimed to evaluate the cost-utility of MS in asthma exacerbations. We used a decision tree model to estimate the cost-utility of MS compared to treatment without MS (control group) in children with asthma exacerbations. Cost data were obtained from a retrospective study from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Probabilistic sensitivity analysis was carried out using the Monte Carlo technique with a simulation of a hypothetical cohort of 10 000 patients to generate expected cost utilities with 95% confidence intervals. We used a cost-effectiveness acceptability curve to evaluate the uncertainty surrounding the cost-utility of MS. The model showed that MS had a lower total cost than the control group (US $1149 vs US $1598 average cost per patient) and higher quality-adjusted life years (0.60 vs 0.52 average per patient), showing dominance. The probability that MS provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds. Intravenous MS was less expensive and more effective than treatment without intravenous MS in children with asthma exacerbations. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate its results in other middle-income countries.

Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE—Retrospective AMI Study

ObjectiveIn 2001, Chinese guidelines for the care of acute myocardial infarction (AMI) included a new recommendation against the routine use of magnesium. We studied temporal trends and institutional variation in...

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Intravenous Magnesium Sulfate for Multimodal Analgesia

Purpose Statement Magnesium Sulfate has been used as a multimodal approach for analgesia as it may reduce opioid consumption in the first 24 hours after surgery and decrease post-operative pain scores. Introduction The use of intraoperative opioids for analgesia is associated with postoperative side effects such as respiratory depression, ileus, nausea, and vomiting. The side effects from opioids can prolong hospital stay and cause patient dissatisfaction. Magnesium acts as a N-methyl-D-aspartate (NMDA) receptor antagonist resulting in an analgesic effect, which can be used as an alternative or adjunct to opioids for pain control. Literature Review Magnesium sulfate may be beneficial for multimodal pain management as it reduces opioid requirements and postoperative pain. Targeting various receptors in the pain pathway can optimize analgesia and reduce side effects. Magnesium antagonizes the NMDA receptor and blocks calcium channels to modulate pain and inflammatory responses. Perioperative magnesium administration should be considered as a strategy to reduce postoperative pain in patients undergoing surgical procedures. Description of the Case A 67-year-old female presented for a bilateral breast revision, bilateral blepharoplasty of upper lids, neck rhytidectomy, and fat graft injection surgery. The patient had a history of postoperative nausea and vomiting. During the maintenance phase of anesthesia, fentanyl 50 mcg was given as needed for signs of pain, rocuronium was re-dosed to maintain paralysis, and ephedrine and phenylephrine were administered to maintain blood pressure. Intravenous magnesium sulfate 2 g was administered as a multimodal approach to analgesia to decrease post-operative opioid consumption and to prevent post-operative nausea and vomiting. The following day the patient tolerated a regular diet, pain was well controlled, and was hemodynamically stable. The patient was discharged home without complications. Discussion and Conclusion Magnesium sulfate may be beneficial for multimodal pain management as it reduces opioid requirements and postoperative pain. Magnesium antagonizes the NMDA receptor and blocks calcium channels to modulate pain and inflammatory responses. It is unclear which mode of magnesium administration provides an advantage to the analgesic effects. The differences in age and gender-related responses to magnesium for analgesia is undetermined. Further research is necessary to examine the use of intravenous magnesium sulfate for postoperative pain in different patient populations, safe and effective dosing ranges, and the effects of analgesia in various surgeries. Intravenous magnesium sulfate should be considered in multimodal analgesic treatment as an adjunct for postoperative analgesia.

The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery

Introduction:The aim of this systematic review is to investigate the effects of perioperative intravenous administration of MgSO4 on postoperative pain, analgesic consumption and adverse effects in patients undergoing orthopedic surgery.Methods:Two investigators independently searched for articles on randomized controlled trials (RCTs) from 1998 to 2016 in Pubmed, Web of science and Google scholar. We evaluated clinical outcomes, comparing postoperative pain scores, cumulative analgesic consumption, time to first analgesia, and adverse effects between orthopedic surgery patients with and without the administration of MgSO4.Results:After screening 2350 articles, 11 RCTs (with a total sample size of 535 subjects) were included in this systematic review. Perioperative intravenous administered MgSO4 could reduce postoperative pain intensity compared with control in 6 trials (55%), but without significant difference in 5 trials (45%). With MgSO4 treatments, postoperative analgesic consumption was significantly reduced in 8 trials (73%), and without significant difference in 2 trials (18%). Two trials evaluated the time to first request of analgesic after surgery and showed prolong of 2.3 hours and 93 minutes respectively. MgSO4 group had less postoperative nausea (relative risk [RR] = 0.32, 95% confidence interval [CI] = 0.12–0.82, number needed to harm [NNH] = 8.8), vomiting (RR = 0.38, 95% CI = 0.15–0.92, NNH = 9.7), and shivering (RR = 0.31, 95% CI = 0.11–0.88, NNH = 5.2).Conclusion:Perioperative intravenous administration of MgSO4 in orthopedic surgery could reduce postoperative analgesic consumption and adverse effects such as vomiting, nausea, and shivering. These trials do not provide convincing evidence of beneficial effects on postoperative pain intensity and the time to first analgesic request. More trials should be conducted for the roles of MgSO4 in pain management for orthopedic surgery. However, intravenous MgSO4 administration should be considered as a strategy to relieve postoperative pain in orthopedic surgery patients.

Medication Regimens for Managing Acute Asthma.

Asthma exacerbation is defined as a progressive increase in symptoms of shortness of breath, cough, or wheezing sufficient to require a change in therapy. After ruling out diagnoses that mimic an asthma exacerbation, therapy should be initiated. Short-acting β2 agonists and short-acting muscarinic antagonists are effective as bronchodilators for asthma in the acute setting. Systemic corticosteroids to reduce airway inflammation continue to be the mainstay therapy for asthma exacerbations, and, unless there is a contraindication, the oral route is favored. Based on the current evidence, nebulized magnesium should not be routinely used in acute asthma. The evidence favors the use of intravenous magnesium sulfate in selected cases, particularly in severe exacerbations. Methylxanthines have a minimum role as therapy for asthma exacerbations but may be considered in refractory cases of status asthmaticus with careful monitoring of toxicity. Current guidelines recommend the use of helium-oxygen mixtures in patients who do not respond to standard therapies or those with severe disease.

Nebulised magnesium sulphate in the management of asthma.

While the use of intravenous magnesium sulphate (MgSO4) is an accepted part of the pharmacological management of patients with asthma, there is conflicting information about whether it is beneficial in its nebulised form.

Why is Postoperative Atrial Fibrillation Difficult to Prevent and Treat: Potential Roles of Unrecognized Magnesium Deficiency and Release of Ceramide and Platelet-Activating Factor

Post-operative atrial fibrillation (POAF) is the most prevalent complication after cardiac or lung surgery, occurring in about 20-50 percent of these patients [1-5]. This event often leads to increased morbidity, thromboembolisms, strokes and long-term mortality resulting in recurring hospitalizations and increased costs. Often the cause(s) of POAF is not known. Age, previous history of atrial fibrillation (AF), hypertension, diabetes, myocardial infarction, valvular heart disease, left ventricular hypertrophy, obesity, excessive drinking of alcohol and excessive smoking present great risk factors for development of POAF [15]. According to a number of reports, the incidence of cerebral infarction and heart failure can increase two-four fold after PAOF [1-5]. Added to this, are a number of growing autopsy studies which demonstrate that many of the PAOF patients, who have died, have considerable atherosclerotic plaques on the walls of the coronary vessels leading to the idea that inflammatory events probably play an important role in the PAOF syndrome [5]. POAF is usually managed by digoxin, calcium channel blockers, betablockers, quinidine, amiodarone, direct current cardioversion, catheter ablation inside the heart, or appropriate rate control techniques to restore rhythm to normal [1-5]. Although digoxin is often utilized, it can present direct risks for POAF patients and has been associated with increased hospitalizations and mortalities [6, 7]. Such data has raised serious concerns about use of digoxin, one of our oldest and most controversial drugs . Ever since 1935 [8], digoxin and cardiac glycosides have been known to deplete the human body and heart of magnesium (Mg) [for review, see [9]]. Several studies have suggested that use of intravenous magnesium sulfate may be better than either betablockers, calcium channel blockers, or amiodarone [1, 5, 10-12]. This concept is currently under investigation by several groups in the USA and Europe. Abstract

Optimizing the use of intravenous magnesium sulfate for acute asthma treatment in children.

Asthma is the most common pediatric chronic disease and currently affects 7.1 million children in the United States. Many children experience acute asthma exacerbations. Many children also require hospitalization despite treatment in an emergency department with current standard therapy (corticosteroids, albuterol, and ipratropium). These hospitalizations may be avoided if effective adjunctive therapies can be developed to adequately treat severe exacerbations. Publications were searched in the PubMed database using the following keywords: magnesium AND asthma AND children AND randomized controlled trial. A total of 30 publications were returned. References of relevant articles were also screened. We included publications of controlled randomized trials where intravenous magnesium sulfate was studied in children (age < 18 years) with acute asthma (n = 7). We excluded studies in adults or trials with other formulations of magnesium (e.g., nebulized). Previous studies have demonstrated that intravenous magnesium sulfate (IV MgSO4 ) significantly improves respiratory function and reduces hospitalization rate in children with moderate to severe asthma exacerbations. Current dosing regimens involve a short infusion of 25-75 mg/kg over 20 min (maximum 2-2.5 g/dose), though no studies have directly compared dosages for relative efficacy. Several studies suggest utilizing a peak plasma concentration of magnesium higher than 4 mg/dL as a surrogate of efficacy. This review summarizes the literature regarding the use of IV MgSO4 for the treatment of pediatric acute asthma. We suggest that optimized dosing regimens could be developed using a linked pharmacokinetic-pharmacodynamic modeling and simulation approach. We propose the factors that should be considered in future clinical trial design in order to better understand the use of IV MgSO4 in pediatric acute asthma. Pediatr Pulmonol. 2016;51:1414-1421. © 2016 Wiley Periodicals, Inc.

Use of intravenous magnesium sulfate for the treatment of an acute asthma exacerbation in pediatric patients.

The standard of care for treatment of an asthma exacerbation includes oxygen, inhaled short-acting bronchodilators, and systemic corticosteroids; adjunctive therapies, such as intravenous magnesium sulfate, can be used for patients who are having life-threatening exacerbations. The purpose of this study was to analyze the prescribing patterns as well as the safety of intravenous magnesium sulfate for the treatment of acute asthma exacerbations in pediatric patients across multiple hospitals in New Jersey. This retrospective chart review was conducted at 4 medical centers in New Jersey on patients who presented to the emergency department between January 1, 2010, and December 31, 2010. Fifty-three patients were included in the study. In the emergency department, 98% of patients received inhaled albuterol plus ipratropium and 85% received systemic corticosteroids before intravenous magnesium sulfate administration. The median dose of magnesium sulfate was 40 mg/kg with a median time of administration of 20 minutes. One patient experienced hypotension that was thought to be related to magnesium sulfate administration. This study demonstrates that weight-based dosage, as well as time of administration of magnesium sulfate for pediatric patients with an acute asthma exacerbation, varies across different institutions in New Jersey. Magnesium sulfate use was safe in this patient population.

N-acetyl cysteine in aluminum phosphide poisoning: Myth or hope.

N-acetyl cysteine in aluminum phosphide poisoning: Myth or hope.

Rapid resolution of akinetic mutism in delayed post-hypoxic leukoencephalopathy with intravenous magnesium sulfate

Delayed post-hypoxic leukoencephalopathy is a rare condition marked by the development of neuropsychiatric symptoms, parkinsonism and akinetic mutism days to weeks after an individual has recovered from a prolonged cerebral hypoxic event. This syndrome can cause significant long-term neurologic dysfunction. At present there are no acute treatment strategies that have been identified that have been shown to alter the natural course of this disorder. In most instances all that can be offered to patients is early supportive care and then subsequent rehabilitation services. Case Report. A patient is presented who developed new onset encephalopathy, extrapyramidal symptoms and akinetic mutism three weeks after being discharged for a respiratory arrest from a drug overdose. MRI showed the development of extensive white matter and bilateral globus pallidus lesions. She had rapid resolution of akinetic mutism with intravenous magnesium sulfate as well as improvement in her other associated neurologic symptoms. The case report suggests the use of intravenous magnesium sulfate as an acute treatment for the akinetic mutism associated with delayed post-hypoxic leukoencephalopathy. In addition it also may improve the extrapyramidal and neuropsychiatric symptoms associated with this syndrome. This may be the first potential acute treatment for this rare neurologic condition.

Uso do sulfato de magnésio venoso para tratamento da asma aguda grave da criança no pronto-socorro

Severe acute asthma is a medical emergency that must be quickly diagnosed and treated. Initial treatment includes a bronchodilator agent and systemic corticosteroids. In severe cases with poor response to the standard treatment, intravenous magnesium sulfate is a therapeutic option. This article aimed a literature review on the use of intravenous magnesium sulfate in the emergency room treatment of children with acute asthma. The treatment parameters of effectiveness, indication, dosage, adverse effects and contraindications were assessed. A narrative review of the literature based on a search of the Medline and Lilacs databases and the Cochrane Database of Systematic Reviews for articles published between 2000 and 2010 was conducted. The keywords used included the following: asthma, children, emergency and magnesium sulfate. Eight controlled clinical trials, three meta-analyses, one retrospective study, eight review articles and one cross-sectional study were included. A total of 21 articles were analyzed. Several authors reported that intravenous magnesium was effective in the treatment of acute asthma in children. Adverse effects were rare. The use of intravenous magnesium sulfate was indicated for patients with moderate to severe acute asthma not responding to initial treatment with a bronchodilator agent and systemic corticosteroids. Few contraindications were reported but included kidney failure and atrioventricular block. Reports of adverse drug interactions with magnesium were rare. Although reported as safe, intravenous magnesium is infrequently used in children with acute asthma. Most often it is used in severe, progressed cases to prevent respiratory failure and/or admission to the intensive care unit. Intravenous magnesium was concluded to be effective and safe in children with severe acute asthma, although its use in the emergency room is still limited.

Magnesium sulphate in the treatment of acute asthma: evaluation of current practice in adult emergency departments

Background: A recent meta-analysis showed that intravenous and nebulised magnesium sulphate have similar levels of evidence to support their use in the treatment of acute asthma in adults. This consisted...