Elsevier

The Journal of Pediatrics

Volume 129, Issue 6, December 1996, Pages 809-814
The Journal of Pediatrics

Intravenous magnesium therapy for moderate to severe pediatric asthma: Results of a randomized, placebo-controlled trial,☆☆,

https://doi.org/10.1016/S0022-3476(96)70023-9Get rights and content

Abstract

OBJECTIVE: To evaluate the efficacy of intravenous magnesium (IVMg) therapy for moderate to severe asthma exacerbations in pediatric patients. DESIGN: Randomized, double-blind, placebo-controlled, clinical trial. SETTING: Urban pediatric emergency department. PARTICIPANTS: Thirty-one patients aged 6 to 18 years who were being treated for an acute asthma exacerbation with peak expiratory flow rate (PEFR) less than 60% of the predicted value after receiving three β2-adrenergic nebulizer treatments. INTERVENTIONS: Magnesium sulfate infusion, 25 mg/kg (maximum, 2 gm), or equivolume saline solution for 20 minutes. MEASUREMENTS AND RESULTS: Vital signs, O2 saturation by pulse oximetry, PEFR, forced vital capacity, forced expiratory volume at 1 second, and physical examination were serially recorded for 110 minutes, with serum magnesium concentrations measured before and after the 20-minute infusion. At 50 minutes the magnesium group had a significantly greater percentage of improvement from baseline in forced expiratory volume at 1 second (34% vs -1%; p = 0.05); this improvement was sustained and even greater at 110 minutes (75% vs 5%; p = 0.01). Results were similar for PEFR at 80 through 110 minutes (59% vs 20% at 110 minutes; p = 0.05) and for forced vital capacity (55% vs 8% at 80 minutes; p = 0.05). There were no significant intergroup differences in blood pressure at any point. Patients who received intravenous magnesium infusions were more likely to be discharged home from the emergency department than those who received placebo (4/15 vs 0/16; p = 0.03). CONCLUSIONS: Children treated with intravenous magnesium infusions for moderate to severe asthma had significantly greater improvement in short-term pulmonary function without any significant alteration in blood pressure, suggesting a role for this agent as an adjunct in the treatment of such patients. (J Pediatr 1996;129:809-14)

Section snippets

METHODS

This clinical trial was approved by the Children's Hospital Boston Institutional Review Board and was conducted from Sept. 20, 1993, through Dec. 20, 1994. All patients 6 to 18 years of age coming to the emergency department at Children's Hospital Boston with an acute asthma exacerbation were evaluated for the study. Peak expiratory flow rate was measured in patients who had required three nebulized β2-adrenergic treatments while in the emergency department. This measurement was performed with

RESULTS

Thirty-one patients completed the study. Mean age was 11.4 ± 3.5 years; 35% were less than 10 years old, and 45% were female. Fifteen patients were randomly assigned to the magnesium group and 16 to the placebo group. The Table illustrates that baseline demographic and clinical variables were not significantly different between the two groups on enrollment into the study, with the exception of FEV1, which was 33.1 ± 11.4 in the IVMg group and 45.1 ± 12.2 in the control group (p = 0.01).

Table.

DISCUSSION

This randomized, controlled trial of IVMg treatment demonstrates the clinical benefit in pediatric patients with moderate to severe asthma. The improvement associated with magnesium therapy was reflected in a higher percentage of improvement in PEFR, FEV1, and FVC and in a lower rate of hospital admission.

A worthwhile measure of therapeutic benefit is the number of patients who would require the intervention under study for one patient to have the outcome of interest.16 On the basis of our

Acknowledgements

We thank Dr. Gary Fleisher, the emergency medicine fellows, and the nursing staff at the Children's Hospital Boston for their assistance in the completion of this study.

References (19)

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    A retrospective review that assessed prescribing patterns of IV magnesium for acute asthma exacerbations in pediatric patients at four hospitals found the median magnesium sulfate dose was 40 mg/kg over an average of 20 min; with doses ranging from 20 to 50 mg/kg over 20–180 min Kokotajlo, Degnan, Meyers, Siu, & Robinson, 2014). A randomized double-blinded, placebo-controlled trial by Ciarallo, Sauer & Shannon (1996) assessed 31 pediatric patients (aged 6–18 years) being treated for an acute asthma exacerbation with either magnesium sulfate or a saline solution (Ciarallo et al., 1996). Patients treated with IV magnesium sulfate were found to have greater improvement in short-term pulmonary function tests than the placebo group.

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From the Division of Emergency Medicine and the Program in Clinical Pharmacology/Toxicology, Children's Hospital Boston, the Department of Pediatrics, Harvard Medical School, Boston, and the Massachusetts Poison Control System, Boston

☆☆

Reprint requests: Lydia Ciarallo, MD, Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.

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