Unorthodox Magnesium

[hammerpcp]

Magnesium for asthma exacerbation? Has anyone ever heard of and/or witnesses this treatment? I hear it's damn near miraculous in its effectiveness. So my question is why isn’t this standard treatment? If you know anything about this please share.

[akflightmedic]

First, is this really Hammerpcp???? Where have you been?????

Second, this treatment is not unorthodox, has been around for a very long time and it works phenomonally. I have used it on several occassions when other methods have failed.

My last patient was a 43 y/o female that was inacute distress upon arrival, didn't respond to beta agonists and was getting ready to buy a tube. Did a little mag sulfate administration and she completely turned around, it was a good feeling for both of us.

I agree it is an underused treatment for which there is no practical answer that I know of. I do recall an article questioning that very same thing. The drug is inexpensive and readily avaliable, so why isn't it used more often? It has always been an option however in the last few providers I have worked for.

[ERDoc]

I use it quite often for more severe asthma and COPD cases. I don't think it is used as much as it should for fear of Mag toxicity. Great little drug that works by smooth muscle relaxation, but you need to watch your pt for toxicity,

[hammerpcp]

I use it quite often for more severe asthma and COPD cases. I don't think it is used as much as it should for fear of Mag toxicity. Great little drug that works by smooth muscle relaxation, but you need to watch your pt for toxicity,

ERDoc,

The person who told me about this, recounted that the Dr (one who came up from Louisiana or some such place) said that they could administer as much mag as they wanted because there was little chance of adverse effects. Mind you this info is third hand, but could you tell us more about mag toxicity? What are the risks? What kind of dosages are therapeutic and what are harmful?

Apparently none of the doc's on in the ER that night had ever heard of such a bizarre treatment. I am dumfounded.

And AK,

No this is not Hammerpcp, this is just a pleasant dream. :wink:

[AZCEP]

The evidence is still being gathered as to how effective it actually is.

By itself, it's not going to do much for the problem. In concert with the beta-2s and steroids, it is great stuff. It works particularly well for the exacerbation that has tried to get relief with multiple MDI doses and can't.

The biggest risk of mag toxicity is sedation/apnea. Mind you it takes a metric @$$load to get that far, but it is a risk. 1-2 grams over 2-5 minutes, repeating as needed is not going to be a huge problem. In the event it doesn't work, you will probably end up ventilating/intubating anyway.

[ERDoc]

ERDoc,

The person who told me about this, recounted that the Dr (one who came up from Louisiana or some such place) said that they could administer as much mag as they wanted because there was little chance of adverse effects. Mind you this info is third hand, but could you tell us more about mag toxicity? What are the risks? What kind of dosages are therapeutic and what are harmful?

Apparently none of the doc's on in the ER that night had ever heard of such a bizarre treatment. I am dumfounded.

And AK,

No this is not Hammerpcp, this is just a pleasant dream. :wink:

Here is a link to an OB website, but hey Mag on L&D is the same as Mag in the ER/ambulance.

http://www.ismp.org/newsletters/acutecare/...es/20051020.asp

[EMS_Cadet]

We have it in our protocols.

[Ridryder 911]

I use it to refractory combi nebs, and found it will usually break the cycle. Have been doing for years.. without any major s/e..

R/r 911

[croaker260]

We have it in our protocols

[tniuqs]

Trust hammer to show up out of the blue, and forward an interesting controversy;

So a pleasant dream or nightmare?

Sorry DOC and the rest of you:

Mag sulfate is a trace element (elecrtolye as we know) it is used on spec. with those that may have nutritional or ETOH abuse PMHX in our CCUs. Poor nutrition has been linked with some of the population of asthmatic/ obese children.

Fact of the matter is one needs a whole heck of a lot of Mag. Sulf. to see loss of DEEP TENDON reflexes. Mag Sulfate was used for years to slow premature delivery, but we loaded 4 times the standard dosage that one presently carries on car these days, for torsades.

You know....... I can not believe that EMS and some ERs have jumped on this "BANDWAGON"... now..... for those evidence based medicine dudes and duddettes, I challenge you and throw down this gauntlet.

1- I bet $$$$ that for every anecdotal remark that Ventolin and Atrovent (concomitantly) is already on board as with "standard of care" in patient treatment and usually (MS) started within 15 minutes. So the question is: Just what are the peak effects/vs time with Ventolin.....hmmmmm....your going to tell me M. S. this is definitive conclustion to patient improvement?......please think again, cough, splutter, wheeze.

2-Your comparing 2 drug modalities at the very the same time and drawing the a concusion......NONSENSE! Your beating the horse with 2 whips, this so NOT science.

3- SHOW ME THE STUDIES! for every one you show me I will show you a study that disproves it, The first (study?) was a young asthmatic female that was weaned from a ventilator....this study is totally a shame and has absolutly no EMS application.

4- That said: the discovery that Salbutamol was effective for use in smooth muscle relaxation was FIRST noted in the investigation of "slowing of premature delivery". (the patient was also an ashmatic) ps Ventolin IV, in the gravida patient has not been used for years, and disproven to be effective for that condition, just to big of a "hammer" no pun intended. :shock:

5- For hammer...could it be that the uterus and smooth mucle (in the male airways) makes us more in touch with our female side ?...I digress.

6- The use of "early" use of nebulised steroids has far more promising with current studies...google it out, especially paeds.

Ok: For the research crowd in EMS...a very rare breed....put together a study to actually study this supposed phenomenon in EMS....but medical legal ethical questions will get in the way....this I put $$$ on too.

Off to soak my feet in Epsom Salts!

cheers