Magnesium Sulfate for Bronchospasm

Pediatric Critical Care Columnist · Jan 9, 2012

I don't know about the other PICU nurses who post here but I can't remember the last time our docs used mag for bronchospasm. We give it to neonates with arrhythmias or post-transplant, but if given in larger doses (more than 0.1 mL/kg of the 50% solution) or at faster rates, it causes significant hypotension... which could worsen acidosis in a bronchospastic patient. We'd go with nebulized epinephrine followed by nebulized albuterol and if that failed after several treatments. we'd go to an albuterol infusion. Ketamine is also something we've used for acute bronchospasm; it's quite effective.

PICUrn08 · Jan 13, 2012

Magnesium is still a large part of our "asthma pathway" (albuterol/atrovent nebs x 3, solumedrol, Mg, continuous albuterol news).... I've never seen a "minimum age" that we've used it on...the typical dose would be 75 mg/kg and given over 20-30 min. This can cause a significant hypotension, but we usually try and give them a fluid bolus before and after the Mg if needed. I've also seen great success with managing asthma with heli-ox (a mixture of helium and oxygen--my facility typically uses 70% He and 30% O2) Since helium is a smaller particle than oxygen, it binds with the oxygen and allows it to be carried past any airway obstructions to the lower airways. We only use ketamine on our super sick asthmatics that we believe are WAY past the point of the asthma pathway.

Hope this helps!

-M

Rookie12 · Jan 20, 2012

We also still use mag regularly in our asthma pathway. I haven't seen the use of ketamine for status asthmaticus at our facility yet, though I am still new :) we use terbutaline IV if continuous nebs aren't effective.

RN_PICU · Jan 28, 2012

In severe cases (usually kids who started smoking with underlying asthma) we use

albuterol gtt (up to 20mg/hr)

D51/2NS 20K

Ketamine

terbutaline

mag-sulfate (until mag levels are around 4)

and if needed 40meq K (just to balance off terbutaline and albuterol effects)

all this with bi-pap tx for as long as needed.

The youngest kid we treated with the above was, if i remember right, less than a year old. Not sure if age has anything to do with it, but i'll ask and get back to you...