pem pearl: High dose magnesium in asthma
TLDR: Small study in 2016 showed that high dose Mg (50mg/kg/hr over 4 hours) in the pED decreased admissions, upgrades, and healthcare costs for severe asthma exacerbations.
Details: 2016 study published in Pediatric Critical Care Medicine. Performed in Peds ED in Paraguay. Randomized 38 patients who weren’t improving at 2 hours of standard treatment. Half the patients received standard treatment, the other half received 50mg/kg/hr high dose Mg infusion (HDMI) for 4 hours in addition to standard therapy. 47% of children in HDMI group were discharged at 24 hours, vs 10% in standard group. Length of stay was reduced by about 12 hours overall. Overall cost was reduced by about 25% in the HDMI group as well. No adverse effects were reported.
My thoughts: The study does not have great power, but the data is intriguing. Overall, the data seems to support the use of magnesium for asthma exacerbations. More research should be done on high dose magnesium for more severe exacerbations, but it may be worth a shot in our sicker patients, as it seems to be safe, cost effective, and with the limited data here, may make a difference in patient outcomes.
Details: 2016 study published in Pediatric Critical Care Medicine. Performed in Peds ED in Paraguay. Randomized 38 patients who weren’t improving at 2 hours of standard treatment. Half the patients received standard treatment, the other half received 50mg/kg/hr high dose Mg infusion (HDMI) for 4 hours in addition to standard therapy. 47% of children in HDMI group were discharged at 24 hours, vs 10% in standard group. Length of stay was reduced by about 12 hours overall. Overall cost was reduced by about 25% in the HDMI group as well. No adverse effects were reported.
My thoughts: The study does not have great power, but the data is intriguing. Overall, the data seems to support the use of magnesium for asthma exacerbations. More research should be done on high dose magnesium for more severe exacerbations, but it may be worth a shot in our sicker patients, as it seems to be safe, cost effective, and with the limited data here, may make a difference in patient outcomes.
