Does IV magnesium treatment for asthma lead to hospitalization?

Guidelines currently recommend administering intravenous magnesium sulfate for refractory pediatric asthma in the emergency department, but hospitalization rates tied to asthma have been stable. An investigation in JAMA Network Open looked at whether receiving intravenous magnesium sulfate therapy was linked to subsequent hospitalization.¹

Investigators performed a post hoc secondary analysis of a double-blind randomized clinical trial of children who had acute asthma and were treated from September 2011 to November 2019 in 7 Canadian tertiary care pediatric emergency departments. Children with Pediatric Respiratory Assessment Measure scores that were 5 points or higher following an initial treatment with systemic corticosteroids and inhaled albuterol with ipratropium bromide were randomized to either receive 3 nebulized treatments of albuterol plus intravenous magnesium sulfate (40-75 mg/kg) or 3 nebulized treatments of albuterol plus an intravenous 5.5% saline placebo.

There were 816 children included in the study of which 364 were hospitalized. There were 215 children who were given intravenous magnesium sulfate, of which 190 were hospitalized. By comparison only 174 of the 601 children who did not get intravenous magnesium sulfate were hospitals. Factors linked to hospitalization included an increase in Pediatric Respiratory Assessment Measure score at disposition (per 1-U increase: odds ratio [OR], 2.24; 95% CI, 1.89-2.65; P < .001), utilization of additional albuterol (OR, 5.94; 95% CI, 3.52-10.01; P < .001), and receiving intravenous magnesium sulfate from 2011 to 2016 (OR, 22.67; 95% CI, 6.26-82.06; P < .001) as well as from 2017 to 2019 (OR, 4.19; 95% CI, 1.99-8.86; P < .001). Administration of intravenous magnesium sulfate was linked to hospitalization in children who had a disposition Pediatric Respiratory Assessment Measure score of 3 or lower (OR, 8.52; 95% CI, 2.96-24.41; P < .001).

The investigators concluded that after adjusting for patient-level characters that receiving intravenous magnesium sulfate therapy after an initial asthma treatment in the emergency department was linked to subsequent hospitalization and existed even among children with mild asthma at emergency department disposition.

Reference

1. Schuh S, Freedman S, Zemek R, et al. Association between intravenous magnesium therapy in the emergency department and subsequent hospitalization among pediatric patients with refractory acute asthma. JAMA Netw Open. 2021;4(7):e2117542. doi:10.1001/jamanetworkopen.2021.17542