Acute asthma management with IV magnesium in obese, overweight and non-overweight inner-city children

Abstract

Objective

IV Magnesium (IV Mg) is increasingly used as adjunctive therapy for asthma exacerbations. In obese patients, delays in recognition of asthma severity may lead to delays in IV Mg administration. Our objective was to examine whether timing of IV Mg administration varied by Body Mass Index (BMI) category and whether this relates to hospitalization course.

Methods

This is a retrospective chart review of IV Mg use for asthma in children 2–17 years of age hospitalized in an urban children’s hospital. Weight status was categorized by BMI percentile for age. The primary outcome was time to IV Mg administration. Secondary outcomes included admission to the intensive care unit, time to discharge readiness and Length of Stay (LOS). Continuous variables were analyzed using Student’s t-test or Mann-Whitney test, categorical variables with Chi-Square test or Fisher’s exact test, as appropriate. A linear regression model examined factors related to time to IV Mg administration.

Results

In 2017, 361/698 (52%) of patients admitted with acute asthma received IV Mg. Of these, 210 patients met study criteria. Except for age, baseline characteristics did not vary by BMI category. No differences were found in Time to IV Mg, rates of admission to the intensive care unit, time to discharge readiness, or LOS comparing non-overweight to overweight or obese patients.

Conclusions

In this sample of inner-city children who received IV Mg there were no differences in timing of IV Mg based on BMI category. Further work is needed to examine whether standardizing timing of IV Mg improves care.

Keywords:

• Asthma pathway
• obesity
• hospital based medicine
• pediatrics

Acknowledgements

Thank you to Aileen McGinn, Ph.D, for her unwavering help and support with the completion of this project.

Declaration of interest

The authors have no conflicts of interest relevant to this article to disclose. This project was supported in part by the National Institutes of Health, National Center for Advancing Translational Sciences through Einstein-Montefiore Clinical and Translational Science Awards (grant UL1TR001073). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.