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Higher-Dose Intravenous Magnesium Therapy for Children With Moderate to Severe Acute Asthma
Lydia Ciarallo, MD;
David Brousseau, MD;
Steven Reinert, MS
Arch Pediatr Adolesc Med. 2000;154:979-983.
Objective To evaluate the efficacy of a 40-mg/kg dose of intravenous magnesium sulfate for moderate to severe asthma exacerbations in pediatric patients.
Study design Double-blind placebo-controlled trial.
Setting Two urban tertiary care pediatric emergency departments.
Subjects Thirty patients, aged 6 to 17.9 years, being treated for an acute asthma exacerbation.
Intervention Eligible patients received either a magnesium sulfate infusion of 40 mg/kg or saline solution.
Results At 20 minutes, the time at which the infusion was completed, the magnesium group had a significantly greater percentage of absolute improvement from baseline in each of the following: predicted peak expiratory flow rate (8.6% vs 0.3%, P<.001), forced expiratory volume in 1 second (7.0% vs 0.2%,P<.001), and forced vital capacity (7.3% vs –0.7%, P<.001). The improvement was greater at 110 minutes: peak expiratory flow rate (25.8% vs 1.9%, P<.001), forced expiratory volume in 1 second (24.1% vs 2.3%; P<.001), and forced vital capacity (27.3% vs 2.6%, P<.001). Patients who received intravenous magnesium were more likely to be discharged to their homes than those who received the placebo (8/16 vs 0/14; P= .002).
Conclusion Children treated with 40 mg/kg of intravenous magnesium sulfate for moderate to severe asthma showed remarkable improvement in short-term pulmonary function.
From the Department of Pediatrics, Brown University School of Medicine and Department of Emergency Medicine, Rhode Island Hospital (Drs Ciarallo and Brousseau), and the Lifespan Medical Computing Department, Rhode Island Hospital (Mr Reinert), Providence.
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