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Optimizing the use of intravenous magnesium sulfate for acute asthma treatment in children
Author(s) -
Liu Xiaoxi,
Yu Tian,
Rower Joseph E.,
Campbell Sarah C.,
Sherwin Catherine M.T.,
Johnson Michael D.
Publication year - 2016
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23482
Subject(s) - medicine , asthma , dosing , emergency department , randomized controlled trial , dose , clinical trial , intensive care medicine , pediatrics , anesthesia , psychiatry
Summary Background Asthma is the most common pediatric chronic disease and currently affects 7.1 million children in the United States. Many children experience acute asthma exacerbations. Many children also require hospitalization despite treatment in an emergency department with current standard therapy (corticosteroids, albuterol, and ipratropium). These hospitalizations may be avoided if effective adjunctive therapies can be developed to adequately treat severe exacerbations. Methods Publications were searched in the PubMed database using the following keywords: magnesium AND asthma AND children AND randomized controlled trial. A total of 30 publications were returned. References of relevant articles were also screened. We included publications of controlled randomized trials where intravenous magnesium sulfate was studied in children (age < 18 years) with acute asthma (n = 7). We excluded studies in adults or trials with other formulations of magnesium (e.g., nebulized). Results Previous studies have demonstrated that intravenous magnesium sulfate (IV MgSO 4 ) significantly improves respiratory function and reduces hospitalization rate in children with moderate to severe asthma exacerbations. Current dosing regimens involve a short infusion of 25–75 mg/kg over 20 min (maximum 2–2.5 g/dose), though no studies have directly compared dosages for relative efficacy. Several studies suggest utilizing a peak plasma concentration of magnesium higher than 4 mg/dL as a surrogate of efficacy. This review summarizes the literature regarding the use of IV MgSO 4 for the treatment of pediatric acute asthma. Conclusions We suggest that optimized dosing regimens could be developed using a linked pharmacokinetic–pharmacodynamic modeling and simulation approach. We propose the factors that should be considered in future clinical trial design in order to better understand the use of IV MgSO 4 in pediatric acute asthma. Pediatr Pulmonol. 2016;51:1414–1421. © 2016 Wiley Periodicals, Inc.