HIGH-DOSE INTRAVENOUS MAGNESIUM-SULFATE IN THE MANAGEMENT OF LIFE-THREATENING STATUS-ASTHMATICUS

In severe status asthmaticus basic medical treatment often fails to im prove the patient's condition. Mechanical ventilation in this situatio n is associated with a high incidence of serious complications. After the bronchodilating effect of moderate-dose magnesium sulfate in asthm atic patients had been demonstrated in previous studies we treated fiv e mechanically ventilated patients with refractory status asthmaticus successfully with high dosages of MgSO4 IV (10- 20 g within 1 h depend ing on the bronchodilating effect). MgSO4 resulted in a significant de crease of peak airway pressure (43.0+/-6.8 to 32.0+/-8.0 cmH(2)O) and inspiratory flow resistance (22.7+/-7.0 to 11.9+/-6.0 cmH(2)O.l(-1).s( -1)) within 1 h. The resulting serum magnesium levels after one hour w ere up to threefold of the normal serum levels. Although a maintainanc e dose of 0.4 g/h had been administered continuously during the follow ing 24 h serum magnesium decreased towards normal values within this t ime. The only relevant side-effect was a mild to moderate arterial hyp otension in two of the five patients during the high dose administrati on period of MgSO4 which responded readily to dopamine treatment.