A female pediatric patient with bronchial asthma respiratory failure treated with potentially effective intravenous magnesium sulfate

Abstract

We successfully treated a female pediatric patient with bronchial asthma respiratory failure by intravenous infusion of magnesium sulfate (MgSO₄), thus avoiding tracheal intubation. At 2 years and 11 months old, the patient suffered from wheezing and dyspnea. She was diagnosed with bronchial asthma respiratory failure and then hospitalized. She received an intravenous steroid infusion, a continuous intravenous infusion of aminophylline, and continuous nebulized inhalation of isoproterenol. However, her respiratory status did not improve, and agitation and hypercapnea occurred. Although we initially considered performing tracheal intubation, to avoid such an invasive procedure, we first attempted an intravenous infusion of 50 mg/kg MgSO₄ over 20 min. Her consciousness and respiratory state improved immediately. After 1 h, the concentration of carbon dioxide in arterial blood, heart rate, and respiratory rate decreased from 54.9 to 46.5 mmHg, from 157 to 126 beats/min, and from 48 to 40 breaths/min, respectively. No adverse effects of MgSO₄ were observed. MgSO₄ is considered to lead to an increase in the degree of calcium extrusion from smooth muscle cells and to inhibit smooth muscle contraction. MgSO₄ has potential as an effective rapid-acting agent and is worth administering to avoid tracheal intubation particularly for children who exhibit a poor response to initial therapy.