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. 2016 May-Jun;21(3):233-8.
doi: 10.5863/1551-6776-21.3.233.

Comparison of Two High-Dose Magnesium Infusion Regimens in the Treatment of Status Asthmaticus

Danish Vaiyani  1 , Jose E Irazuzta  1
Affiliations

Comparison of Two High-Dose Magnesium Infusion Regimens in the Treatment of Status Asthmaticus

Danish Vaiyani et al. J Pediatr Pharmacol Ther. 2016 May-Jun.

Abstract

Objectives: To determine the feasibility and safety of a simplified high-dose magnesium sulfate infusion (sHDMI) for the treatment of status asthmaticus.

Methods: We retrospectively compared 2 different high-dose magnesium sulfate infusion regimens, as adjunctive treatment in status asthmatics, using data that were preciously collected. The initial high-dose, prolonged magnesium infusion (HDMI) regimen consisted of a loading dose of 75 mg/kg (weight ≤ 30 kg) or 50 mg/kg (weight > 30 kg) over a period of 30 to 45 minutes followed by a continuous infusion of 40 mg/kg/hr for an additional 4 hours. This was compared to the sHDMI regimen that consisted of 50 mg/kg/hr for 5 hours. No loading dose was given to the patients in the sHDMI arm. Obese patients were dosed by using ideal body weight. Physiologic parameters (i.e., heart rate, blood pressure, respiratory rate, oxygen saturation) and serum magnesium (SrMg) concentrations were monitored during administration of magnesium sulfate.

Results: Nineteen patients receiving the initial HDMI regimen were compared with 10 patients who received the sHDMI regimen. There was no significant difference in SrMg concentrations or physiologic parameters between the 2 dose regimens.

Conclusions: The HDMI and sHDMI regimens both produced SrMg concentrations that are associated with bronchodilation. The safety profile was also similar for the 2 regimens. The unambiguity of sHDMI has the potential to reduce medication errors that are associated with calculation of the loading dose, product preparation, and ultimate administration.

Keywords: asthma; infusion; magnesium sulfate; pediatric; status asthmaticus.

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Figures

Figure 1.
Figure 1.
Comparison of resultant serum magnesium concentration in the HDMI and sHDMI regimens during 4 hours of administration. HDMI, high-dose magnesium infusion (includes loading dose); sHDMI, simplified high-dose magnesium infusion (without a loading dose); SrMg, serum magnesium The bottom line of the box-and-whisker plot represents the 25th percentile and the upper line of the box is the 75th percentile. The line in the middle of the box represents the median and the diamond depicts the mean.
Figure 2.
Figure 2.
Effects of HDMI and sHDMI regimens during 4 hours of administration on hemodynamic parameters and heart rate. DBP, diastolic blood pressure; HDMI, high-dose magnesium infusion (includes loading dose); HR, heart rate; SBP, systolic blood pressure; sHDMI, simplified high-dose magnesium infusion (without a loading dose). The bottom line of the box-and-whisker plot represents the 25th percentile and the upper line of the box is the 75th percentile. The line in the middle of the box represents the median and the diamond depicts the mean.
Figure 3.
Figure 3.
Effects of HDMI and sHDMI regimens during 4 hours of administration on oxygen saturation and respiratory rate. HDMI, high-dose magnesium infusion (includes loading dose); sHDMI, simplified high-dose magnesium infusion (without a loading dose); RR, respiratory rate; SpO2, oxygen saturation. The bottom line of the box-and-whisker plot represents the 25th percentile and the upper line of the box is the 75th percentile. The line in the middle of the box represents the median and the diamond depicts the mean.
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