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Magnesium sulphate intravenously reduces tachycardia side-effects of β2-agonists

William F.S. Sellers, Michael F.M. James
Breathe 2022 18: 220015; DOI: 10.1183/20734735.0015-2022
William F.S. Sellers
1Retired Anaesthetist, Great Easton, UK
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  • For correspondence: wfssellers@doctors.org.uk
Michael F.M. James
2Faculty of Health Sciences, Anaesthesia, University of Cape Town, Cape Town, South Africa
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Abstract

Intravenous magnesium sulphate allows safer intravenous β2-agonist delivery in acute-severe and life-threatening asthma attacks https://bit.ly/3veUpfC

To the Editor:

The review by Erumbala et al. [1] correctly proposing magnesium sulphate (MgSO4) as the first intravenous bronchodilator missed vital points of its pharmacological actions. The i.v. drug reduces or eliminates tachycardia and palpitation side-effects of β2-agonists [2–5]. As well as relaxing smooth muscle of the bronchi, vasculature, gut and uterus, MgSO4 slows cardiac atrial conduction [6, 7], and was used in the past to revert supraventricular tachycardia and fast atrial fibrillation [8, 9]. There is no evidence to be found for the 20–30 min infusion rate for i.v. MgSO4 of 40–75 mg.kg−1, and this infusion time will not create a sufficiently high serum level to relax bronchial smooth muscle. In acute-severe and life-threatening asthma i.v. MgSO4 followed by i.v. β2-agonist is safe [10]; an infusion time of 5 min for MgSO4 has evidence for the safety of this speed of injection in obstetric [11] and cardiac literature, albeit in adults.

Footnotes

  • Conflict of interest: The authors have no conflict of interest.

  • Received February 7, 2022.
  • Accepted February 12, 2022.
  • Copyright ©ERS 2022
http://creativecommons.org/licenses/by-nc/4.0/

Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

References

  1. ↵
    1. Erumbala G,
    2. Anzar S,
    3. Tonbari A, et al.
    Stating the obvious: intravenous magnesium sulphate should be the first parenteral bronchodilator in paediatric asthma exacerbations unresponsive to first-line therapy. Breathe 2021; 17: 210113. doi:10.1183/20734735.0113-2021
    OpenUrl
  2. ↵
    1. Sellers WFS,
    2. Ahmad I,
    3. Bathke PS, et al.
    Intravenous magnesium sulphate prevents intravenous salbutamol tachycardia in asthma. Br J Anaesth 2010; 105: 869–870. doi:10.1093/bja/aeq329
    OpenUrlCrossRefPubMed
    1. Edwin JV,
    2. Panikkar K
    . Re: IV mag sulphate prevents iv salbutamol tachycardia. https://academic.oup.com/bja/article/105/6/869/324942#usercomments Date last updated: 6 March 2011.
    1. Barker D,
    2. Chin H
    . Use of magnesium in moderating tachycardia in acute severe asthma in pregnancy. Br J Anaesth 2013; 110: 1059. doi:10.1093/bja/aet146
    OpenUrlCrossRefPubMed
  3. ↵
    1. Elton J,
    2. Mclachlan K,
    3. Amarasekara A, et al.
    High dose fast delivery magnesium sulphate in a 3-year-old acute severe asthmatic. AMJ 2007; 10: 826–828. doi:10.21767/AMJ.2017.3153
    OpenUrl
  4. ↵
    1. Piotrowski AA,
    2. Kalus JS
    . Magnesium for the treatment and prevention of atrial tachyarrhythmias. Pharmacotherapy 2004; 24: 879–895. doi:10.1592/phco.24.9.879.36092
    OpenUrlCrossRefPubMed
  5. ↵
    1. Ramussen HS,
    2. Thomsen PEB
    . The electrophysiological effects of intravenous magnesium on human sinus node, atrioventricular node, atrium, and ventricle. Clin Cardiol 1989; 12: 85–90. doi:10.1002/clc.4960120204
    OpenUrlCrossRefPubMed
  6. ↵
    1. Wesley RC,
    2. Haines DE,
    3. Lerman BB, et al.
    Effect of intravenous magnesium sulfate on supraventricular tachycardia. Am J Cardiol 1989; 63: 1129–1131. doi:10.1016/0002-9149(89)90092-1
    OpenUrlCrossRefPubMed
  7. ↵
    1. Viskin S,
    2. Belhassen B,
    3. Sheps D, et al.
    Clinical and electrophysiologic effects of magnesium sulfate on paroxysmal supraventricular tachycardia and comparison with adenosine triphosphate. Am J Cardiol 1992; 70: 879–885. doi:10.1016/0002-9149(92)90731-D
    OpenUrlCrossRefPubMed
  8. ↵
    1. Sellers WFS
    . Inhaled and intravenous treatment in acute severe and life-threatening asthma. Br J Anaesth 2013; 110: 183–190. doi:10.1093/bja/aes444
    OpenUrlCrossRefPubMed
  9. ↵
    1. James MF
    . Magnesium in obstetrics. Best Pract Res Clin Obstet Gynaecol 2010; 24: 327–337. doi:10.1016/j.bpobgyn.2009.11.004
    OpenUrlCrossRefPubMed
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Magnesium sulphate intravenously reduces tachycardia side-effects of β2-agonists
William F.S. Sellers, Michael F.M. James
Breathe Mar 2022, 18 (1) 220015; DOI: 10.1183/20734735.0015-2022

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Magnesium sulphate intravenously reduces tachycardia side-effects of β2-agonists
William F.S. Sellers, Michael F.M. James
Breathe Mar 2022, 18 (1) 220015; DOI: 10.1183/20734735.0015-2022
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