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Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease.
Pediatrics. 2013 Dec; 132(6):e1634-41.Ped

Abstract

BACKGROUND AND OBJECTIVE

Vaso-occlusive episodes (VOEs) are the most common complication of sickle cell disease in children. Treatment with magnesium seems to improve cellular hydration and may result in reduced vaso-occlusion. This study aimed to determine if intravenous (IV) magnesium sulfate (MgSO4) reduces length of stay (LOS) in hospital, pain scores, and cumulative analgesia when compared with placebo.

METHODS

Randomized, double-blind, placebo-controlled trial in children aged 4 to 18 years requiring admission to hospital with a sickle cell disease VOE requiring IV analgesia. Participating children received IV MgSO4 (100 mg/kg) every 8 hours or placebo in addition to standard therapy. We used a t test or Mann-Whitney test (continuous variables), Fisher's exact test, or χ2 test (frequencies). P values were considered significant if <.05, and 95% confidence intervals were calculated for the difference between groups.

RESULTS

One hundred six children were randomly assigned to the study, and 104 were included. Fifty-one (49%) received MgSO4. Children's mean age was 12.4 years (range: 4-18 years; SD: 3.8 years), and 56 (54%) were females. There was no significant difference in the primary outcome measure, LOS in hospital, with a mean of 132.6 and 117.7 hours in the MgSO4 and placebo groups, respectively (P = .41). There was no significant difference between groups for the secondary outcomes of mean pain scores (4.9 ± 2.6 vs 4.8 ± 2.6, respectively; P = .92) or analgesic requirements (continuous morphine infusion [P = .928], boluses of IV morphine [P = .82], acetaminophen [P = .34], ibuprofen [P = .15], naproxen [P = .10]). Only minor adverse events were recorded in both groups. Pain at the infusion site was more common in the MgSO4 group.

CONCLUSIONS

IV MgSO4 was well tolerated but had no effect on the LOS in hospital, pain scores, or cumulative analgesia use in admitted children with a VOE.

Authors+Show Affiliations

Division of Pediatric Emergency Medicine, BC Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. rgoldman@cw.bc.ca.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24276838

Citation

Goldman, Ran D., et al. "Intravenous Magnesium Sulfate for Vaso-occlusive Episodes in Sickle Cell Disease." Pediatrics, vol. 132, no. 6, 2013, pp. e1634-41.
Goldman RD, Mounstephen W, Kirby-Allen M, et al. Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease. Pediatrics. 2013;132(6):e1634-41.
Goldman, R. D., Mounstephen, W., Kirby-Allen, M., & Friedman, J. N. (2013). Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease. Pediatrics, 132(6), e1634-41. https://doi.org/10.1542/peds.2013-2065
Goldman RD, et al. Intravenous Magnesium Sulfate for Vaso-occlusive Episodes in Sickle Cell Disease. Pediatrics. 2013;132(6):e1634-41. PubMed PMID: 24276838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease. AU - Goldman,Ran D, AU - Mounstephen,William, AU - Kirby-Allen,Melanie, AU - Friedman,Jeremy N, Y1 - 2013/11/25/ PY - 2013/11/27/entrez PY - 2013/11/28/pubmed PY - 2014/1/29/medline KW - admission KW - children KW - magnesium KW - pain KW - sickle cell disease KW - vaso-occlusive episode SP - e1634 EP - 41 JF - Pediatrics JO - Pediatrics VL - 132 IS - 6 N2 - BACKGROUND AND OBJECTIVE: Vaso-occlusive episodes (VOEs) are the most common complication of sickle cell disease in children. Treatment with magnesium seems to improve cellular hydration and may result in reduced vaso-occlusion. This study aimed to determine if intravenous (IV) magnesium sulfate (MgSO4) reduces length of stay (LOS) in hospital, pain scores, and cumulative analgesia when compared with placebo. METHODS: Randomized, double-blind, placebo-controlled trial in children aged 4 to 18 years requiring admission to hospital with a sickle cell disease VOE requiring IV analgesia. Participating children received IV MgSO4 (100 mg/kg) every 8 hours or placebo in addition to standard therapy. We used a t test or Mann-Whitney test (continuous variables), Fisher's exact test, or χ2 test (frequencies). P values were considered significant if <.05, and 95% confidence intervals were calculated for the difference between groups. RESULTS: One hundred six children were randomly assigned to the study, and 104 were included. Fifty-one (49%) received MgSO4. Children's mean age was 12.4 years (range: 4-18 years; SD: 3.8 years), and 56 (54%) were females. There was no significant difference in the primary outcome measure, LOS in hospital, with a mean of 132.6 and 117.7 hours in the MgSO4 and placebo groups, respectively (P = .41). There was no significant difference between groups for the secondary outcomes of mean pain scores (4.9 ± 2.6 vs 4.8 ± 2.6, respectively; P = .92) or analgesic requirements (continuous morphine infusion [P = .928], boluses of IV morphine [P = .82], acetaminophen [P = .34], ibuprofen [P = .15], naproxen [P = .10]). Only minor adverse events were recorded in both groups. Pain at the infusion site was more common in the MgSO4 group. CONCLUSIONS: IV MgSO4 was well tolerated but had no effect on the LOS in hospital, pain scores, or cumulative analgesia use in admitted children with a VOE. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/24276838/Intravenous_magnesium_sulfate_for_vaso_occlusive_episodes_in_sickle_cell_disease_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=24276838 DB - PRIME DP - Unbound Medicine ER -