title: Randomised trial of magnesium in the treatment of Irukandji syndrome.
abstract: OBJECTIVE
  Irukandji syndrome is a distressing condition characterised by pain, hypertension and tachycardia. Some develop cardiac failure and there have been two reported deaths. Magnesium sulphate has become the standard of care despite minimal evidence. The aim of this study was to investigate if magnesium would reduce analgesic requirement and length of stay for patients with Irukandji syndrome.
  
  
  METHODS
  This was a double-blind, randomised controlled clinical trial. Patients with Irukandji syndrome who required parenteral opioid analgesia were randomised to receive either 10 mmol of magnesium as a bolus, and then a 5 mmol/h magnesium infusion for 6 h or saline. Fentanyl patient-controlled analgesia was commenced to allow patients to self-regulate their pain relief. The primary outcome measure of the study was comparison of total analgesic requirements between the two groups. The secondary outcome measure was to compare length of stay.
  
  
  RESULTS
  The study ran from November 2003 to May 2007. Thirty-nine patients were enrolled in the study; 26 were male with a median age of 28. Twenty-two received magnesium. There was no significant difference in the morphine equivalent dose used, peak CK, peak troponin, peak pulse, peak blood pressure, peak mean arterial pressure (MAP), percentage MAP rise and length of stay for those receiving magnesium compared with placebo.
  
  
  CONCLUSIONS
  Our study did not demonstrate a benefit in the use of magnesium in the treatment of Irukandji syndrome. As such the current use of magnesium needs to be reconsidered until there is good evidence to support its use.
authors.affiliation: Emergency Department, Cairns Base Hospital, Cairns, Queensland, Australia.
authors.forename: Nora
authors.initials: N
authors.lastname: McCullagh
authors.forename: Peter
authors.initials: P
authors.lastname: Pereira
authors.forename: Paul
authors.initials: P
authors.lastname: Cullen
authors.forename: Richard
authors.initials: R
authors.lastname: Mulcahy
authors.forename: Robert
authors.initials: R
authors.lastname: Bonin
authors.forename: Mark
authors.initials: M
authors.lastname: Little
authors.forename: Suzanne
authors.initials: S
authors.lastname: Gray
authors.forename: Jamie
authors.initials: J
authors.lastname: Seymour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000704:Analysis of Variance; D000818:Animals; D001733:Bites and Stings / Q000188:drug therapy* / Q000473:pathology; D003064:Cnidarian Venoms / Q000009:adverse effects* / Q000737:chemistry; D016001:Confidence Intervals; D037462:Cubozoa / Q000737:chemistry*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D003064:Cnidarian Venoms; D008278:Magnesium Sulfate; D005283:Fentanyl