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High-dose magnesium sulfate infusion protocol for status asthmaticus: a safety and pharmacokinetics cohort study

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Abstract

Purpose

To assess the safety and pharmacokinetics of high-dose magnesium sulfate (MgSO4) infusion in pediatric patients with status asthmaticus.

Methods

A prospective cohort study within a 20-bed pediatric intensive care unit in an academic community hospital. Patients 2–18 years of age admitted with status asthmaticus between 10/2009 and 8/2010 were included in the study. All patients received standard therapy for asthma, while the treatment group received an intravenous magnesium sulfate bolus of 50–75 mg/kg (0.2–0.3 mmol/kg) followed by 40 mg/kg/h (0.16 mmol/kg/h) for 4 h. Patients were monitored for cardiorespiratory complications. The treatment group underwent four blood draws to assess pharmacokinetic parameters.

Results

Nineteen patients were in the treatment group and 38 patients in the control group after exclusion criteria and consenting were completed. No clinically significant differences were found between groups. There were no interventions or discontinuations of MgSO4 due to adverse events. In the treatment group, three patients had mild infusion-related reactions. Heart rate and respiratory rate were statistically significantly lower in the magnesium treatment group.

Conclusions

The continuous infusions of MgSO4 were safe at the studied doses and maintained serum magnesium (SrMg) and ionized magnesium levels similar to levels required to produce smooth muscle relaxation in other clinical settings. Further studies are needed to investigate the efficacy of high-dose continuous MgSO4 infusion as an adjunctive treatment for severe asthma treatment and determine the SrMg level required to maintain airway smooth muscle relaxation.

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Acknowledgments

Attending physicians in the WCH PICU (enrolled/consented patients); PA/ARNP in the WCH PICU (enrolled/consented patients); nursing staff in the WCH PICU (specific ADR and hemodynamic monitoring).

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Authors and Affiliations

  1. Wolfson Children’s Hospital/Baptist Health, Jacksonville, USA

    Tosha A. Egelund, Sarah K. Wassil, Elisa M. Edwards & Jose E. Irazuzta

  2. University of Florida, Gainesville, USA

    Stephan Linden

  3. University of Florida, Jacksonville, USA

    Jose E. Irazuzta

Authors
  1. Tosha A. Egelund
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  2. Sarah K. Wassil
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  3. Elisa M. Edwards
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  4. Stephan Linden
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  5. Jose E. Irazuzta
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Corresponding author

Correspondence to Tosha A. Egelund.

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Egelund, T.A., Wassil, S.K., Edwards, E.M. et al. High-dose magnesium sulfate infusion protocol for status asthmaticus: a safety and pharmacokinetics cohort study. Intensive Care Med 39, 117–122 (2013). https://doi.org/10.1007/s00134-012-2734-6

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  • DOI: https://doi.org/10.1007/s00134-012-2734-6

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