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Higher-Dose Magnesium Is Helpful for Children with Moderate-to-Severe Asthma

The role of magnesium in acute, severe pediatric asthma remains unclear. These investigators evaluated magnesium at a higher dose than has been studied previously.

Thirty children 6 to 18 years old and presumed to be resistant to standard bronchodilators (peak flow < 70 percent predicted after 3 treatments) were randomized to receive infusions of 40 mg/kg magnesium sulfate (2 g maximum) or normal saline over 20 minutes. All patients received corticosteroids. Pulmonary function tests were performed at baseline and during and after the infusions. Treating physicians determined subsequent disposition and need for additional medications.

The 2 groups were similar in demographic and clinical variables and therapies given in the ED. The magnesium group had significantly greater improvement in all pulmonary function parameters at all time points (20 to 110 minutes) after the infusion (P < 0.001). All placebo patients required hospitalization, versus only 50 percent of magnesium patients (P < 0.002). No discharged patient required additional emergency care or hospitalization. No magnesium toxicities were reported.

Comment: The effects of magnesium were so striking that the trial was terminated early. Not all trials of magnesium in adults show similar benefits, and these authors suggest that children may be more responsive because they have younger, healthier respiratory systems. Regardless of why, weight-based dosing with IV magnesium appears to be safe and effective for children with moderate to severe asthma. It can be added to a standard regimen of bronchodilators and corticosteroids to improve short-term pulmonary function and may prevent the need for hospitalization.

— JM Baren

Published in Journal Watch Emergency Medicine January 31, 2001

Citation(s):

Ciarallo L et al. Higher-dose intravenous magnesium therapy for children with moderate to severe acute asthma. Arch Pediatr Adolesc Med 2000 Oct 154 979-983.

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