Use of magnesium sulfate in continuous infusion in patients with severe acute asthma, in a pediatric emergency room

Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting

Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.

Pediatric pulmonology 2021 year in review: Asthma

Asthma is the most common chronic disease in children, affecting an estimated 6.1 million children in the United States. SARS-CoV2 had a significant impact on asthma exacerbations and healthcare utilization of patients with asthma in 2021. Additionally, studies in 2021 influenced the field of asthma with improvements in diagnostic testing and monitoring, treatment of severe exacerbations, social determinants of health, and evaluation of medical costs. This article is part of our 2021 "Year in Review" series, in which we summarize publications in major pulmonary topics, in the context of selected literature from other journals relevant to our discipline.

Risk factors for hyponatremia in acute exacerbation chronic obstructive pulmonary disease (AECOPD): a multicenter cross-sectional study

BACKGROUND

Hyponatremia is an independent predictor of poor prognosis, including increased mortality and readmission, in COPD patients. Identifying modifiable etiologies of hyponatremia may help reduce adverse events in patients with AECOPD. Therefore, the aim of this study was to explore the risk factors and underlying etiologies of hyponatremia in AECOPD patients.

METHODS

A total of 586 AECOPD patients were enrolled in this multicenter cross-sectional study. Finally, 323 had normonatremia, and 90 had hyponatremia. Demographics, underlying diseases, comorbidities, symptoms, and laboratory data were collected. The least absolute shrinkage and selection operator (LASSO) regression was used to select potential risk factors, which were substituted into binary logistic regression to identify independent risk factors. Nomogram was built to visualize and validate binary logistics regression model.

RESULTS

Nine potential hyponatremia-associated variables were selected by LASSO regression. Subsequently, a binary logistic regression model identified that smoking status, rate of community-acquired pneumonia (CAP), anion gap (AG), erythrocyte sedimentation rate (ESR), and serum magnesium (Mg²⁺) were independent variables of hyponatremia in AECOPD patients. The AUC of ROC curve of nomogram was 0.756. The DCA curve revealed that the nomogram could yielded more clinical benefits if the threshold was between 10% and 52%.

CONCLUSIONS

Collectively, our results showed that smoking status, CAP, AG, ESR, and serum Mg²⁺ were independently associated with hyponatremia in AECOPD patients. Then, these findings indicate that pneumonia, metabolic acidosis, and hypomagnesemia were the underlying etiologies of hyponatremia in AECOPD patients. However, their internal connections need further exploration.