title: Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease.
abstract: OBJECTIVE
  Vaso-occlusive episodes (VOEs) are the most common complication of sickle cell disease in children. Treatment with magnesium seems to improve cellular hydration and may result in reduced vaso-occlusion. This study aimed to determine if intravenous (IV) magnesium sulfate (MgSO4) reduces length of stay (LOS) in hospital, pain scores, and cumulative analgesia when compared with placebo.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled trial in children aged 4 to 18 years requiring admission to hospital with a sickle cell disease VOE requiring IV analgesia. Participating children received IV MgSO4 (100 mg/kg) every 8 hours or placebo in addition to standard therapy. We used a t test or Mann-Whitney test (continuous variables), Fisher's exact test, or χ2 test (frequencies). P values were considered significant if <.05, and 95% confidence intervals were calculated for the difference between groups.
  
  
  RESULTS
  One hundred six children were randomly assigned to the study, and 104 were included. Fifty-one (49%) received MgSO4. Children's mean age was 12.4 years (range: 4-18 years; SD: 3.8 years), and 56 (54%) were females. There was no significant difference in the primary outcome measure, LOS in hospital, with a mean of 132.6 and 117.7 hours in the MgSO4 and placebo groups, respectively (P = .41). There was no significant difference between groups for the secondary outcomes of mean pain scores (4.9 ± 2.6 vs 4.8 ± 2.6, respectively; P = .92) or analgesic requirements (continuous morphine infusion [P = .928], boluses of IV morphine [P = .82], acetaminophen [P = .34], ibuprofen [P = .15], naproxen [P = .10]). Only minor adverse events were recorded in both groups. Pain at the infusion site was more common in the MgSO4 group.
  
  
  CONCLUSIONS
  IV MgSO4 was well tolerated but had no effect on the LOS in hospital, pain scores, or cumulative analgesia use in admitted children with a VOE.
authors.affiliation: Division of Pediatric Emergency Medicine, BC Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. rgoldman@cw.bc.ca.
authors.forename: Ran D
authors.initials: RD
authors.lastname: Goldman
authors.forename: William
authors.initials: W
authors.lastname: Mounstephen
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirby-Allen
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D014665:Vasodilator Agents; D008278:Magnesium Sulfate
keywords: admission; children; magnesium; pain; sickle cell disease; vaso-occlusive episode