WIP 36 - Timely Administration of IV Magnesium Sulfate in Patients with a Moderate Asthma Exacerbation.

Publication Number: WIP 36.7605

Jaclyn Urquiola Sorzano, Oklahoma University, Yukon, OK, United States; Ryan S. McKee, MD, OU Health Sciences Center, Oklahoma City, OK, United States; Fatima I. Sukhera, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States

Background: Status asthmaticus is one of the most common diagnoses seen in the pediatric emergency department (ED). Asthma is the most common chronic disease among children and adolescents affecting over 4 million children with a mortality rate of 2.8 per million. Most pediatric EDs across the country have protocols and algorithms in place to treat status asthmaticus which include bronchodilators, ipratropium, and systemic steroids as first line therapy. Magnesium sulfate is considered second line therapy and recommendations vary in many protocols where it is most often mentioned to “consider” in the case of a moderate exacerbation. This leads to a variation in administration from the initial hour to two to three hours after the start of bronchodilators. There is little to no literature on optimal timing of administration of magnesium sulfate in the setting of status asthmaticus.

Objective: This study aims to evaluate whether administering magnesium sulfate within the first hour of presentation alongside first line therapies will decrease length of stay in the ED and overall hospital stay, decrease the need for intensive care services, and decrease the need for advanced respiratory support (i.e., NIV, mechanical ventilation) in patients with moderate asthma exacerbations.

Design/Methods: This is a randomized control trial approved by IRB and registered on clinicaltrials.org. Patients aged 5-17 presenting to our tertiary care pediatric emergency department from May 2024 to March 2025 will be assigned a respiratory score (RS) upon presentation. Those with a RS between 6-9 (moderate exacerbation) will be screened for inclusion. The patients randomized to the experimental group will receive weight-based IV magnesium (40-50mg/kg) within the first hour and the control group might receive standard weight-based IV magnesium sulfate per the provider’s clinical judgement pending their response to bronchodilators. Enrolled patients will have their clinical course reviewed and data obtained to evaluate the objective measures described above. We are actively enrolling patients.