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CASE REPORT
Year : 2012  |  Volume : 26  |  Issue : 1  |  Page : 14-15

Miracle of magnesium sulfate


Department of Emergency Medicine, PESIMSR, Kuppam, Chittoor District, Andhra Pradesh, India

Date of Web Publication10-Dec-2012

Correspondence Address:
P Mohammed Shabbir
Department of Emergency Medicine, PESIMSR, Kuppam, Chittoor District, Andhra Pradesh - 517 425
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6691.104440

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  Abstract 

A 55 year old female patient, known asthmatic from past ten years, presented to us with history of breathlessness from past five days, cough with expectoration from past five days. On examination patient had severe bronchospasm, tachypnea, respiratory distress, silent chest and her SpO 2 75% on room air. Patient given conventional anti-asthmatics and antibiotics bronchospasm did not relive and SpO 2 did not improve therefore patient intubated paralyzed and put on control mode of ventilation with 100% O 2 patient SpO 2 was between 80 to 85% with persistent bronchospam. Patient continued to have bronchospasm for next 18 hrs even after continued antiasthmatics with steroids. After 18 hrs patient was started on i.v. Magnesium sulfate, 40 mg/kg bolus over 30mins. And 20 mg/kg infusion over 4hrs.patient responded within one hour of treatment bronchospasm decreased patient SpO 2 improved to 95%. Magnesium sulfate infusion continued for next 24 hrs patient was symptoms free, patient extubated observed for next 12 hrs and shifted out of ICU with normal clinical parameters. Hence it may be concluded that i.v. Magnesium sulfate can be considered for patient with acute severe asthma who do not respond to regular anti-asthmatics.

Keywords: Acute severe asthma, intravenous infusion, magnesium sulfate, severe bronchospasm


How to cite this article:
Shabbir P M. Miracle of magnesium sulfate. Indian J Allergy Asthma Immunol 2012;26:14-5

How to cite this URL:
Shabbir P M. Miracle of magnesium sulfate. Indian J Allergy Asthma Immunol [serial online] 2012 [cited 2019 Dec 15];26:14-5. Available from: http://www.ijaai.in/text.asp?2012/26/1/14/104440


  Introduction Top


Acute severe asthma is a life threatening medical emergency if untreated promptly and aggressively can prove to be disastrous for the patient. For ages nebulized beta agonists are standard first line treatment for acute severe asthma along with anti-cholinergics, if no response, steroids and iv bronchodilators like aminophylline is used along with antibiotic therapy. We are presenting here such a case of acute severe asthma that was unresponsive to inhaled beta agonists plus anti-cholinergics, i.v. Aminophylline and hydrocortisone but responded quickly with i.v. Magnesium sulfate therapy.


  Case Report Top


A 55 year old female patient weighing 65 kgs was admitted to our hospital with the history of breathlessness from past five days, cough with expectoration from past 5 days. Patient is a known asthmatic from past ten years with oncounter treatment (without doctor's prescription).

On examination

A 55 year old female patient conscious, cooperative, anxious and alert. Moderately built and nourished. Patient is tachypneic with accessory muscles of respiration in action. Pulse rate: 120 b/min. Blood pressure 160/90 mm of hg. Temperature 100 degree fnt. And respiratory rate of more than 25 cycles/min. with prolonged expiratory phase.

Respiratory system examination bilateral air entry decreased with bilateral crepts and bilateral wheez. On room air patient's SpO 2 was 75%. ABG showing severe respiratory acidosis with PcO 2 of 88 mm of hg, patient was immediately paralyzed and intubated put on control mode of ventilation.

Drugs used

patient was nebulized with salbutamole and budecort neulisation solution, injection hydrocortisone 200 mg i.v. stat and 100 mg tid started since the bronchospasm did not relieve inj. aminophylline 5 mg/kg given along with antibacterial coverage as per local sensitivity pattern and other supportive care like antiulcer prophylaxis and dvt prophylaxis. No response therefore increased the aminophylline infusion to 0.7 mg/kg/hr infusion after 2 hrs no response the infusion increased to 1 mg and then 1.5 mg/ kg/ hr which was maximum. After 18 hrs the bronchospasm persisted with SpO 2 between 80-85% with 100% o2. Patient was started on i.v. magnesium sulfate 40mg/ kg bolus and 20 mg/kg infusion over 4 hrs. Bronchospasm relived within 1hr. Infusion continued for next 24 hrs patient was free from bronchospasm. Extubated observed for next 12 hrs and patient was shifted out of ICU with normal clinical parameters. Patient was discharged from the hospital on 8 th day of admission and follow ups were symptom free for a period of 6 mths.


  Discussion Top


When there is need for quick bronchodilatation beta2 agonists remained the main stay in the initial management of acute asthma. However the potential role of other agents in the initial management of acute asthma is still unclear. Aminophylline, many a times, in acute asthma for adults and children failed to demonstrate a beneficial result. Steroids appear to reduce inflammation of bronchial wall and help to avoid hospital admissions. Significant debate exists with respect to benefit of other agents such as magnesium sulfate in the treatment of acute asthma. Magnesium is predominantly intracellular action, is an important co-factor in many enzymatic reactions and is linked to cellular haemostasis. In addition, magnesium has an effect on smooth muscle cells, with hypomagnesemia causing contraction and hypermagnesemia causing relaxation of smooth muscles. There is some evidence that when magnesium is administered to asthmatic patients, it produces bronchodilatation. Because magnesium levels in asthmatics appear to be at same levels as control subjects, the effect may be related to competitive antagonism with calcium. In addition, evidence suggests that magnesium may reduce the nutrophilic burst associated with the inflammatory response in asthma. Thus there is reason to believe that magnesium treatment, in the form of i.v. Magnesium sulfate, may be beneficial in the treatment of acute asthma. The same result was achieved in this patient too.


  Conclusion Top


To conclude, i.v. Magnesium sulfate can be considered for patients with acute severe asthma who do not respond to standard therapeutic medications i.e. regular anti- asthamatics. [14]

 
  References Top

1.Okayama H, Aikawa T, Okayama M, Sasaki H, Mue S, Takishima T. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076-8.  Back to cited text no. 1
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2.Skobeloff EM, Spivey WH, McNamara RM, Greenspon L. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA 1989;262:1210-3.  Back to cited text no. 2
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3.Rodrigo G, Rodrigo C, Burschtin O. Efficacy of magnesium sulfate in acute adult asthma: A meta-analysis of randomized trials. Am J Emerg Med 2000;18:216-21.  Back to cited text no. 3
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4.Mangat HS, D'Souza GA, Jacob MS. Nebulized magnesium sulphate versus nebulized salbutamol in acute bronchial asthma: A clinical trial. Eur Respir J 1998;12:341-4.  Back to cited text no. 4
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5.Nannini LJ Jr, Pendino JC, Corna RA, Mannarino S, Quispe R. Magnesium sulphate as a vehicle for nebulized salbutamol in acute asthma. Am J Med 2000;108:193-7.  Back to cited text no. 5
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6.Bessmertny O, DiGregorio RV, Cohen H, Becker E, Looney D, Golden J, et al. A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults. Ann Emerg Med 2002;39:585-91.  Back to cited text no. 6
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7.Bloch H, Silverman R, Mancherje N, Grant S, Jagminas L, Scharf SM. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest 1995;107:1576-81.  Back to cited text no. 7
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8.Alter HJ, Koepsell TD, Hilty WM. Intravenous magnesium as an adjuvant in acute bronchospasm: A meta-analysis. Ann Emerg Med 2000;36:191-7.  Back to cited text no. 8
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9.Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature. Ann Emerg Med 2000;36:181-90.  Back to cited text no. 9
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10.Rodrigo G, Rodrigo C, Burschtin O. Efficacy of magnesium sulfate in acute adult asthma: a meta-analysis of randomized trials. Am J Emerg Med 2000;18:216-21.  Back to cited text no. 10
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11.Silverman RA, Osborn H, Runge J, Gallagher EJ, Chiang W, Feldman J, et al. IV magnesium sulfate in the treatment of acute severe asthma: A multicenter randomized controlled trial. Chest 2002;122:489-97.  Back to cited text no. 11
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12.Hollander DI, Nagey DA, Pupkin MJ. Magnesium sulfate and ritodrine hydrochloride: A randomized comparison. Am J Obstet Gynecol 1987;156:631-7.  Back to cited text no. 12
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13.Johnson D, Gallagher C, Cavanaugh M, Yip R, Mayers I. The lack of effect of routine magnesium administration on respiratory function in mechanically ventilated patients. Chest 1993;104:536-41.  Back to cited text no. 13
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14.Agus ZS, Wasserstein A, Goldfarb S. Disorders of calcium and magnesium homeostasis. Am J Med 1982;72:473-88.  Back to cited text no. 14
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Abstract
Introduction
Case Report
Discussion
Conclusion
References

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