title: Phase II study of magnesium sulfate in acute organophosphate pesticide poisoning.
abstract: BACKGROUND
  Acute organophosphorus (OP) poisoning is relatively common and a major cause of death from poisoning in developing countries. Magnesium has been shown to be of benefit in animal models.
  
  
  METHODS
  We conducted a phase II study of bolus doses of (MgSO4) in 50 patients with acute organophosphate poisoning. Patients eligible for inclusion had ingested OP and had cholinergic symptoms consistent with moderate or severe poisoning. All patients received standard care of atropinization titrated to control muscarinic symptoms and pralidoxime. The trial was run in 4 sequential groups of patients. Participants in each group received a different total dose of MgSO4 (20%) administered as intermittent bolus doses infused over 10-15 min or placebo. There was one control patient for every 4 patients who received MgSO4. Group A (16 patients) received a total of 4 gm MgSO4 as a single bolus, group B (8 patients) received 8 gm (in two 4 gm doses q4H), group C (8 patients) received 12 gm (in three 4 gm doses q4H) group D (8 patients) received 16 gm (in four 4 gm doses q4H) and control (10 patients) received placebo). Patients were closely monitored for any adverse reaction like significant clinical neuromuscular disturbance and respiratory depression.
  
  
  RESULTS
  No adverse reactions to magnesium were observed. The 24 hour urinary magnesium concentration were statistically different between 16 gm (234.74 ± 74.18 mg/dl) and control (118.06 ± 30.76 mg/dl) (p = 0.019), while it was much lower than the 80% of the intravenous magnesium load. Six patients died in control group compared to 3 in 4 gm, 2 in 8 gm and 1 in 12 gm group. There was no mortality in 16 gm group.
  
  
  CONCLUSIONS
  Magnesium was well tolerated in this study. Larger studies are required to examine for efficacy.
authors: In Charge, SK Hospital, Mymensingh, Bangladesh. arifulbasher@yahoo.com
authors: A
authors: A
authors: Basher
authors: S H
authors: SH
authors: Rahman
authors: A
authors: A
authors: Ghose
authors: S M
authors: SM
authors: Arif
authors: M A
authors: MA
authors: Faiz
authors: A H
authors: AH
authors: Dawson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use; D001459:Bangladesh; D002801:Cholinesterase Reactivators / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D008274:Magnesium / Q000652:urine; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D062025:Organophosphate Poisoning / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D011220:Pralidoxime Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D002801:Cholinesterase Reactivators; D018727:Muscarinic Antagonists; D011220:Pralidoxime Compounds; D008278:Magnesium Sulfate; D001285:Atropine; D008274:Magnesium; C028797:pralidoxime