A randomized trial of magnesium in the emergency department treatment of children with asthma

Study objective: Magnesium sulfate has been shown to benefit asthmatic chil dren and adults with poor responses to initial beta (2)-agonist therapy in the emergency department. We sought to determine whether the routine early administration of high-dose magnesium would benefit moderate to severely il l children with acute asthma. Methods: This was a randomized, double-blind, placebo-controlled trial of 5 4 children 1 to 18 years of age who presented to the ED of a tertiary care children's hospital with a moderate to severe asthma exacerbation. After re ceiving a nebulized albuterol treatment (0.15 mg/kg) and methylprednisolone (1 mg/kg), patients were randomly assigned to receive either 75 mg/kg of m agnesium sulfate (maximum 2.5 g) or placebo. Thereafter, ail patients were treated with frequent nebulized albuterol following a structured protocol. The main outcome was degree of improvement as assessed by Pulmonary Index s cores over 120 minutes. Secondary outcomes included hospitalization rates a nd time required to meet discharge criteria. Results: The mean change in Pulmonary Index score from baseline to 120 minu tes was 2.83 for the magnesium group compared with 2.66 for the placebo gro up (95% confidence interval -1.24 to 1.60). Eleven (46%) of 24 magnesium-tr eated patients were hospitalized compared with 16 (53%) of 30 in the placeb o group (95% confidence interval -19% to 34%). There were no statistically significant differences between the groups with respect to time required to meet discharge criteria. Conclusion: The routine administration of high-dose magnesium to moderate t o severely ill children with asthma, as an adjunct to initial treatment wit h albuterol and corticosteroids, was not efficacious.