USE OF MAGNESIUM SULFATE IN CONTINUOUS INFUSION IN PATIENTS WITH SEVERE
ACUTE ASTHMA, IN A PEDIATRIC EMERGENCY ROOM
Abstract
Introduction: Asthma is a disease with important morbidity and that can
lead to death in childhood. The use of intravenous magnesium sulfate has
been indicated in cases refractory to the initial management with
inhaled bronchodilators and corticosteroids. Objective: To evaluate the
use of magnesium sulfate in continuous infusion (50mg/kg/hour in 4
hours) in children with severe acute asthma. Location: 10-bed pediatric
emergency room, university hospital. Patients: Children over 2 years old
who received a continuous infusion of magnesium sulfate at a dose of
50mg/kg/hour in 4 hours. Methods and main findings: Cross-sectional,
prospective study. All patients with severe acute asthma were included
in a study protocol. A total of 40 patients met the inclusion criteria,
60% male, with a median age of 3.0 years (2.8-4.3). All patients were
monitored and followed by an emergency pediatrician during the 4 hours
of infusion. There was no description of adverse events related to the
magnesium sulfate. The modified Wood-Downes clinical score was applied
and compared before and after the infusion and a significant clinical
improvement was observed (p<0.001). The serum magnesium levels
at the end of the infusion ranged from 3.3-5.8 mg/dL, suitable as
therapeutic and without toxicity (median 4.0). The median length of stay
in pediatric emergency was 2 days. Only 2 patients (5%) were
transferred to the PICU. Conclusions: On this study, the use of
continuous magnesium sulfate proved to be well tolerated, leading to
improved respiratory status, and can be considered as adjunctive therapy
in the management of severe asthma.