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JAMA Aug 2023
Topics: Female; Humans; Infant, Newborn; Pregnancy; Gestational Age; Infant, Premature; Magnesium Sulfate; Neuroprotection; Neuroprotective Agents; Parturition
PubMed: 37581684
DOI: 10.1001/jama.2023.10673 -
Paediatric Anaesthesia Apr 2022
Topics: Administration, Intravenous; Humans; Magnesium; Magnesium Sulfate
PubMed: 35343036
DOI: 10.1111/pan.14405 -
Archives of Gynecology and Obstetrics Jun 2021We aimed to analyze the linear changes of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Immune-Inflammation Index (SII) levels in...
PURPOSE
We aimed to analyze the linear changes of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Immune-Inflammation Index (SII) levels in pregnant women who administrated magnesium sulfate for fetal neuroprotection.
METHODS
This retrospective study included 63 pregnant women who underwent neuroprotective magnesium sulfate administration during January 2015 and July 2020. Women with co-existing diseases or obstetric complications such as preeclampsia, gestational diabetes mellitus, suspicion of chorioamnionitis etc. excluded. The laboratory test results were obtained for each participant. Three results were compared; (1) Before magnesium sulfate-0th hour, (2) 6 h and (3) 12 h after starting loading dose.
RESULTS
The mean NLR was 7.18 ± 5.14 in patients before treatment. The mean NLR increased to 10.09 ± 4.77 and 10.04 ± 4.35 at 6th and 12th hour of magnesium sulfate treatment. The mean PLR was also increased after starting neuroprotective magnesium sulfate (170.35 ± 89.09 at the beginning; 209.85 ± 88.77 at 6th hour and 209.24 ± 76.66 at 12th hour). The mean SII was found to be increased from 1783.33 ± 1367.29 to 2517.15 ± 1325.77 with magnesium sulfate treatment. However, no statistically significant difference was observed in terms of SII between 6 and 12th hours of treatment (p = 0.752). Maternal serum magnesium levels at 6th and 12th hour were found to be not correlated with NLR, PLR and SII.
CONCLUSION
We demonstrated that values of NLR, PLR and SII at 6th hour were all increased after starting magnesium sulfate. Levels of these systemic inflammatory indices were similar at 6th and 12th hour of therapy.
Topics: Biomarkers; Blood Cell Count; Blood Platelets; Female; Humans; Inflammation; Lymphocyte Count; Lymphocytes; Magnesium Sulfate; Neuroprotection; Neutrophils; Platelet Count; Pregnancy; Premature Birth; Retrospective Studies
PubMed: 33222038
DOI: 10.1007/s00404-020-05866-y -
JAMA Network Open May 2024Understanding the effect of antenatal magnesium sulfate (MgSO4) treatment on functional connectivity will help elucidate the mechanism by which it reduces the risk of... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Understanding the effect of antenatal magnesium sulfate (MgSO4) treatment on functional connectivity will help elucidate the mechanism by which it reduces the risk of cerebral palsy and death.
OBJECTIVE
To determine whether MgSO4 administered to women at risk of imminent preterm birth at a gestational age between 30 and 34 weeks is associated with increased functional connectivity and measures of functional segregation and integration in infants at term-equivalent age, possibly reflecting a protective mechanism of MgSO4.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was nested within a randomized placebo-controlled trial performed across 24 tertiary maternity hospitals. Participants included infants born to women at risk of imminent preterm birth at a gestational age between 30 and 34 weeks who participated in the MAGENTA (Magnesium Sulphate at 30 to 34 Weeks' Gestational Age) trial and underwent magnetic resonance imaging (MRI) at term-equivalent age. Ineligibility criteria included illness precluding MRI, congenital or genetic disorders likely to affect brain structure, and living more than 1 hour from the MRI center. One hundred and fourteen of 159 eligible infants were excluded due to incomplete or motion-corrupted MRI. Recruitment occurred between October 22, 2014, and October 25, 2017. Participants were followed up to 2 years of age. Analysis was performed from February 1, 2021, to February 27, 2024. Observers were blind to patient groupings during data collection and processing.
EXPOSURES
Women received 4 g of MgSO4 or isotonic sodium chloride solution given intravenously over 30 minutes.
MAIN OUTCOMES AND MEASURES
Prior to data collection, it was hypothesized that infants who were exposed to MgSO4 would show enhanced functional connectivity compared with infants who were not exposed.
RESULTS
A total of 45 infants were included in the analysis: 24 receiving MgSO4 treatment and 21 receiving placebo; 23 (51.1%) were female and 22 (48.9%) were male; and the median gestational age at scan was 40.0 (IQR, 39.1-41.1) weeks. Treatment with MgSO4 was associated with greater voxelwise functional connectivity in the temporal and occipital lobes and deep gray matter structures and with significantly greater clustering coefficients (Hedge g, 0.47 [95% CI, -0.13 to 1.07]), transitivity (Hedge g, 0.51 [95% CI, -0.10 to 1.11]), local efficiency (Hedge g, 0.40 [95% CI, -0.20 to 0.99]), and global efficiency (Hedge g, 0.31 [95% CI, -0.29 to 0.90]), representing enhanced functional segregation and integration.
CONCLUSIONS AND RELEVANCE
In this cohort study, infants exposed to MgSO4 had greater voxelwise functional connectivity and functional segregation, consistent with increased brain maturation. Enhanced functional connectivity is a possible mechanism by which MgSO4 protects against cerebral palsy and death.
Topics: Humans; Magnesium Sulfate; Female; Pregnancy; Infant, Newborn; Magnetic Resonance Imaging; Male; Adult; Gestational Age; Cohort Studies; Premature Birth; Infant; Brain; Prenatal Care; Cerebral Palsy
PubMed: 38805222
DOI: 10.1001/jamanetworkopen.2024.13508 -
Journal of Investigative Surgery : the... Jun 2019: In this study, we aimed to investigate the therapeutic effects of magnesium sulfate (MgSO) and dexmedetomidine (dex) in a model of acute lung injury (ALI). We...
: In this study, we aimed to investigate the therapeutic effects of magnesium sulfate (MgSO) and dexmedetomidine (dex) in a model of acute lung injury (ALI). We determined whether concomitant administration decreased the inflammatory effects of hydrochloric acid (HCl)-induced ALI in a synergistic manner. : In this study, 42 Sprague-Dawley rats were randomized into six groups: Group S (saline), Group SV (saline + mechanical ventilation), Group HCl (HCl), Group Dex (Dex), Group Mag (MgSO), and Group DM (Dex + MgSO). All groups except Group S were mechanically ventilated prior to HCl-induced ALI. Saline or HCl was administered via tracheostomy. Prior to treatment, HCl was administered to Group HCl, Group Dex, Group Mag, and Group DM to induce ALI. Dex and MgSO were administered intraperitoneally. The rats were monitored for 4 h after treatment to measure oxidative stress parameters in blood, and prolidase enzyme activity. Lung tissue damage were determined via histopathology. : A significant increase in heart rate and rapid desaturation was observed in HCl-administered groups. Treatment administration decreased the pulse values. Increased saturation values and decreased oxidative stress indices were observed in groups that were subsequently administered Dex and MgSO. Serum prolidase activity increased significantly in Group HCl. Severe pathological findings were detected following HCl-induced ALI. Group Mag showed greater improvement in the pathology of HCl-induced ALI than did Group Dex. Administration of both Dex and MgSO did not improve the pathological scores. : The antioxidant and anti-inflammatory effects of Dex and MgSO ameliorated the detrimental effects of HCI-induced ALI. However, adverse effects on hemodynamics and lung damage were observed when the two drugs were administered together.
Topics: Acute Lung Injury; Administration, Intravenous; Animals; Anti-Inflammatory Agents; Antioxidants; Dexmedetomidine; Disease Models, Animal; Drug Synergism; Hemodynamics; Humans; Hydrochloric Acid; Lung; Magnesium Sulfate; Male; Oxidative Stress; Rats; Rats, Sprague-Dawley; Respiration, Artificial; Signal Transduction
PubMed: 29359990
DOI: 10.1080/08941939.2017.1422575 -
Jornal de Pediatria 2017To describe the role of intravenous magnesium sulfate (MgSO) as therapy for acute severe asthma in the pediatric emergency department (ED). (Review)
Review
OBJECTIVES
To describe the role of intravenous magnesium sulfate (MgSO) as therapy for acute severe asthma in the pediatric emergency department (ED).
SOURCE
Publications were searched in the PubMed and Cochrane databases using the following keywords: magnesium AND asthma AND children AND clinical trial. A total of 53 publications were retrieved using this criteria. References of relevant articles were also screened. The authors included the summary of relevant publications where intravenous magnesium sulfate was studied in children (age <18 years) with acute asthma. The NAEPP and Global Initiative for Asthma expert panel guidelines were also reviewed.
SUMMARY OF THE DATA
There is a large variability in the ED practices on the intravenous administration of MgSO for severe asthma. The pharmacokinetics of MgSO is often not taken into account with a consequent impact in its pharmacodynamics properties. The cumulative evidence points to the effectiveness of intravenous MgSO in preventing hospitalization, if utilized in a timely manner and at an appropriate dosage (50-75mg/kg). For every five children treated in the ED, one hospital admission could be prevented. Another administration modality is a high-dose continuous magnesium sulfate infusion (HDMI) as 50mg/kg/h/4h (200mg/kg/4h). The early utilization of HDMI for non-infectious mediated asthma may be superior to a MgSO bolus in avoiding admissions and expediting discharges from the ED. HDMI appears to be cost-effective if applied early to a selected population. Intravenous MgSO has a similar safety profile than other asthma therapies.
CONCLUSIONS
Treatment with intravenous MgSO reduces the odds of hospital admissions. The use of intravenous MgSO in the emergency room was not associated with significant side effects or harm. The authors emphasize the role of MgSO as an adjunctive therapy, while corticosteroids and beta agonist remain the primary acute therapeutic agents.
Topics: Acute Disease; Asthma; Child; Emergency Service, Hospital; Hospitalization; Humans; Infusions, Intravenous; Magnesium Sulfate; Severity of Illness Index
PubMed: 28754601
DOI: 10.1016/j.jped.2017.06.002 -
Nefrologia 2021The study aimed to investigate the role of magnesium sulfate prophylaxis in nephrotoxicity caused by colistin. Thirty Wistar Albino rats were divided into four groups:...
The study aimed to investigate the role of magnesium sulfate prophylaxis in nephrotoxicity caused by colistin. Thirty Wistar Albino rats were divided into four groups: control, colistin, magnesium (Mg), and Mg+colistin. The drugs were administered to the groups for seven days. Urea-creatinine values were measured at the beginning (T0) and end (T1) of the study. Malondialdehyde (MDA) levels were measured in plasma and kidney tissue, glutathione (GSH) levels were analyzed in the erythrocyte and kidney tissues. At the end of the study, the semiquantitative score (SQS) was calculated by the histopathological examination of the kidneys. Urea values significantly decreased in Mg and Mg+colistin groups compared to the baseline (p=0.013 and p=0.001). At the time of T1, these groups had significantly lower urea values than the colistin and control groups. Creatinine value was significantly increased in the colistin group compared to baseline (p=0.005), the creatinine value in the colistin group was significantly higher than the Mg+colistin group (p=0.011). Plasma MDA levels were significantly higher in the colistin group compared to the other groups at the time of T1 (p<0.001). The Mg+colistin group had lower renal MDA levels than the colistin group. The colistin group had significantly higher renal tubular grade (p=0.035), renal affected area (p<0.001), and SQS (p=0.001) than the Mg+colistin group. The results of the study suggested that Mg sulfate may have a nephrotoxicity-reducing effect on colistin.
Topics: Animals; Colistin; Creatinine; Glutathione; Humans; Magnesium; Magnesium Sulfate; Malondialdehyde; Oxidative Stress; Rats; Rats, Wistar; Renal Insufficiency; Urea
PubMed: 36165156
DOI: 10.1016/j.nefroe.2022.01.005 -
BMC Pregnancy and Childbirth Jun 2024To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO)in women with preeclampsia (PE), and to determine the key covariates having an effect in...
OBJECTIVE
To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO)in women with preeclampsia (PE), and to determine the key covariates having an effect in magnesium pharmacokinetics in Chinese PE.
METHODS
Pregnant women with PE prescribed MgSO4 were enrolled in this prospective study from April 2021 to April 2023. On the initial day of administration, the patients were administered a loading dose of 5 g in conjunction with 10 g of magnesium sulfate as a maintenance dose. On the second day, only the maintenance dose was administration, and maternal blood samples were taken at 0, 4, 5, and 12 h after the second day's 10 g maintenance dose. The software Phoenix was used to estimate PPK parameters of MgSO4, such as clearance (CL) and volume of distribution (V), and to model PPK models with patient demographic, clinical, and laboratory covariates.
RESULTS
A total of 199 blood samples were collected from 51 women with PE and PPK profiles were analyzed. The PPK of MgSO is consistent with to a one-compartment model. The base model adequately described the maternal serum magnesium concentrations after magnesium administration. The population parameter estimates were as follows: CL was 2.98 L/h, V was 25.07 L. The model predictions changed significantly with covariates (BMI, creatinine clearance, and furosemide). Furosemide statistically influences V. The creatinine clearance, BMI and furosemide jointly affects CL. Monte Carlo simulation results showed that a loading dose combined with a maintenance dose would need to be administered daily to achieve the therapeutic blood magnesium concentrations. For the non-furosemide group, the optimal dosing regimen was a 5 g loading dose combined with a 10 g maintenance dose of MgSO4. For the furosemide group, the optimal dosing regimen was a 2.5 g loading dose combined with a 10 g maintenance dose of MgSO4.
CONCLUSIONS
The magnesium PPK model was successfully developed and evaluated in Chinese preeclampsia population, and the dose optimization of MgSO was completed through Monte Carlo simulation.
Topics: Humans; Female; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Adult; Prospective Studies; China; Young Adult; Dose-Response Relationship, Drug; East Asian People
PubMed: 38872116
DOI: 10.1186/s12884-024-06620-x -
American Journal of Obstetrics and... Jun 2016Magnesium sulfate is one of the most commonly prescribed intravenous medications in obstetrics. Despite its widespread use, there are limited data about magnesium... (Observational Study)
Observational Study
BACKGROUND
Magnesium sulfate is one of the most commonly prescribed intravenous medications in obstetrics. Despite its widespread use, there are limited data about magnesium pharmacokinetics, and magnesium is prescribed empirically without dose adjustment for different indications.
OBJECTIVE
The aim of this study was to characterize the pharmacokinetics and placental transfer of magnesium sulfate in pregnant women and to determine key covariates that impact the pharmacokinetics.
STUDY DESIGN
This is a prospective pharmacokinetic cohort study of pregnant women who were prescribed magnesium sulfate for preeclampsia, preterm labor, or extreme prematurity. Women received a 4-g loading dose and 2 g/h maintenance dose as clinically indicated. Maternal blood samples were obtained before and at multiple time points during and after magnesium administration. Cord blood also was sampled at delivery. A population pharmacokinetic approach that used a nonlinear mixed-effects modeling was used to characterize magnesium disposition.
RESULTS
Pharmacokinetic profiles of 111 pregnant women were analyzed. Magnesium clearance was 3.98 L/h in preeclamptic women and 5.88 L/h non-preeclamptic women. Steady-state concentration of magnesium was 7.2 mg/dL in preeclamptic women compared with 5.1 mg/dL in non-preeclamptic women. Maternal weight significantly impacted time to steady state. The ratio of the mean umbilical vein magnesium level to the mean maternal serum magnesium level at the time of delivery was 0.94 ± 0.15.
CONCLUSIONS
The study accurately characterizes the pharmacokinetics of magnesium administered to pregnant women. Preeclamptic status and maternal weight significantly impact serum magnesium levels. This pharmacokinetic model could be applied to larger cohorts to help tailor magnesium treatment and account for these covariates.
Topics: Adult; Body Weight; Female; Humans; Magnesium Sulfate; Maternal-Fetal Exchange; Placenta; Pre-Eclampsia; Pregnancy; Prospective Studies; Tocolytic Agents; Umbilical Veins
PubMed: 26767791
DOI: 10.1016/j.ajog.2015.12.060 -
Journal of Veterinary Internal Medicine Mar 2019Trigeminal-mediated headshaking results from low-threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects...
BACKGROUND
Trigeminal-mediated headshaking results from low-threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal-mediated headshaking.
OBJECTIVE
To investigate head-shaking behavior in affected horses after IV magnesium sulfate infusion.
ANIMALS
Six geldings with trigeminal-mediated headshaking.
METHODS
Prospective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextrose solution (DS; control solution at 2 mL/kg body weight [BW]) and MgSO 50% solution (MSS at 40 mg/kg BW). Head-shaking behavior was recorded at times T0 (baseline, before infusion) and T15, T30, T60, and T120 minutes post-infusion. Venous blood variables such as pH, HCO , standard base excess (SBE), Na , Cl , K , Ca , Mg , total magnesium (tMg), glucose, and lactate were measured; strong ion difference (SID) and anion gap (AG) were calculated for each time point.
RESULTS
Blood variables including pH, Na , Cl , K , SID, AG, lactate, Ca , tMg, and Mg had significant changes with MSS as compared to DS treatment. Glucose, SBE, and HCO did not have significant changes. A 29% reduction in head-shaking rate occurred after MSS treatment but no change occurred after DS treatment.
CONCLUSIONS AND CLINICAL IMPORTANCE
Administration of MSS IV increased plasma total and ionized magnesium concentrations and significantly decreased head-shaking behavior in horses with trigeminal-mediated headshaking.
Topics: Animals; Behavior, Animal; Cross-Over Studies; Head; Horse Diseases; Horses; Infusions, Intravenous; Magnesium; Magnesium Sulfate; Male; Prospective Studies; Trigeminal Nerve
PubMed: 30666732
DOI: 10.1111/jvim.15410