efficacy of iv magnesium sulfate in children with acute severe bronchial asthma in khartoum ...

139 Pages·2006·0.49 MB·English

University of Khartoum
The Graduate College
Medical and Health Studies Board

EFFICACY OF IV MAGNESIUM SULFATE IN
CHILDREN WITH ACUTE SEVERE BRONCHIAL
ASTHMA IN KHARTOUM CHILDREN’S
EMERGENCY HOSPITAL

By
DR: NOUR ELDIN YOUNIS HAMID
MBBS (Khartoum)

A thesis submitted in partial fulfillment for the degree of
Clinical MD in Pediatrics and Child Health.

Supervisor
PROF: SALAH AHMED IBRAHIM
MD, FRCP, FRCPCH (UK)
Professor of Pediatrics and Child Health
Faculty of Medicine University of Khartoum
I dedicate this effort to...
The soul of my parents
To my brothers and sisters
To all deprived children throughout Sudan
Thanks to the God,
Thanks to Prof. Salah A. Ibrahim for his kind
supervision, guidance and help throughout the study,
my thanks extend to my colleagues who helped me a
lot in this study.
I thank all the asthmatic children and their families
for participation in the study.
My thanks extends to all those who facilitated to
overcome the difficulties and made my aspirations
possible.
ABSTRACT

Randomized, single blind, case controlled clinical trial conducted in
Khartoum Children’s Emergency Hospital. The aim was to study the
efficacy of IV Mg sulfate in treatment of children with acute severe
asthma.
Seventy-two patients (40males and 32 females) enrolled in the study.
They were selected after they failed to respond to three doses of
nebulized salbutamol and corticosteroids and had PEFR of < 50%
predicted, and then they were randomly divided into tow groups to
receive either a) 40 mg/kg body weight of I.V Mg sulfate in 50ml saline
infusion over 20minutes or an equivalent volume of normal saline. Every
patient in the test group matched with control concerning age and sex.
The vital signs, signs of respiratory distress, PEFR and SaO recorded at
2
zero, 30, 60, 90 and 120 minutes.
The tow groups showed similar results at zero time. At 30 minutes,
the test group showed: PEFR ranged from 90 to 200 L/min VS 75 to150
L/min in control group P<0.015. Moreover, RR from 39 to 61 breath/min
VS 38 to 65 breath/min in control group with P<0.042, and HR from 102
to 135 beat/min VS 108 to 154 beat/min in control group P<0.022. The
Accessory respiratory muscle use at 30 minutes in test group was seen in
29 patients VS 32 patients in control group P<0.024 .
At 60 minutes the PEFR in the test ranged from 100 to 240 L/min VS
75 to150 L/min in control group P<0.0001. The SaO in the test group
2
ranged from 83 to 98 % VS 82 to 94 % in control group P<0.0001; and
the RR from 30 to 53 breath/min VS 35 to 66 breath/min in control group
P<0.007; and HR from 97 to 131 beat/min VS 101 to 151 beat/min in
control group P<0.022. The Accessory respiratory muscle use at 30
minutes in test group was seen in 29 patients VS 32 patients in control
group P<0.040 .
These changes persisted through 90 minutes and even greater at 120
minutes, which showed PEFR ranged from 140 to 330 L/min VS 80
to160 L/min in control group P<0.0001. SaO in the test group ranged
2
from 84 to 99 % VS 85 to 98 % in control group P<0.0001. RR in the test
group ranged from 20 to 43 breath/min VS 34 to 65 breath/min in control
group P<0.001. HR the test group ranged from 81 to 131 beat/min VS 96
to 152 beat/min in control group P<0.001. The Accessory respiratory
muscle use was observed in three patients of the test group VS 32 patients
in control group (P<0.0001).There were no adverse or toxic effects of use
of I.V Mg sulfate.
Conclusion: the use of intravenous magnesium sulfate achieved rapid
clinical response in patients with acute severe asthma without significant
side effects.
ﺔﺣوﺮﻃﻷا ﺺﺨﻠﻣ

(Single Randomized clinical trial ) ﻉﻭـﻨ ﻥـﻤ ﻲـﻫﻭ ﺔـﺴﺍﺭﺩﻟﺍ ﻩﺫﻫ ﺕﻴﺭﺠﺃ
ﻱﺩﻴﺭﻭﻟﺍ ﻡﻭﻴﺯﻴﻨﻏﺎﻤﻟﺍ ﺕﺎﻔﻠﺴ ﺭﺎﻘﻋ ﺔﻴﻟﺎﻌﻓ ﺔﺴﺍﺭﺩ ﺽﺭﻐﺒ ﻡﻭﻁﺭﺨﻟﺍ لﺎﻔﻁﻷﺍ ﺙﺩﺍﻭﺤ ﻲﻔﺸﺘﺴﻤﺒ
لﻜ ﺫﺨﺍ ﻥﺁ ﺩﻌﺒ ﺔﻴﺌﺍﻭﺸﻋ ﺔﻘﻴﺭﻁﺒ لﻔﻁ ٧٢ ﺭﺎﻴﺘﺨﺍ ﻡﺘ . ﺭﻁﺨﻟﺍ ﺩﺎﺤﻟﺍ ﻲﺒﻌﺸﻟﺍ ﻭﺒﺭﻟﺍ ﺕﻻﺎﺤ ﺝﻼﻌﻟ
لﺩـﻌﻤ ﺩـﻴﺭﻭﻟﺎﺒ ﻥﻭﺯﺘﺭﻭﻜﻭﺭﺩﻴﺎﻬﻟﺍﻭ ﻕﺎﺸﻨﺘﺴﻻﺍ ﺔﻘﻴﺭﻁﺒ لﻭﻤﺎﺘﻭﻴﺒﻟﺎﺴ ﻥﻤ ﺕﺎﻋﺭﺠ ﺔﺜﻼﺜ ﻡﻬﻨﻤ
ﺕﻻﺎـﺤﻟﺍ ﻡﻴﺴـﻘﺘ ﻡﺘ ﺎﻫﺩﻌﺒ .ﻊﻗﻭﺘﻤﻟﺍ لﺩﻌﻤﻟﺍ ﻥﻤ 50% < ﻡﻬﻨﻤ ﻱﻷ ﻰﻠﻋﻷﺍ ﻯﺭﻴﻓﺯﻟﺍ ﻉﺎﻓﺩﻨﻻﺍ
50 ﻊﻤ ﻡﻭﻴﺯﻴﻨﻏﺎﻤﻟﺍ ﺕﺎﻔﻠﺴ ﻥﻤ 40 mg/kg ﺎﻫﺍﺩﺤﺇ ﺕﻴﻁﻋﺃ ﺔﻴﺌﺍﻭﺸﻋ ﺔﻘﻴﺭﻁﺒ ﻥﻴﺘﻋﻭﻤﺠﻤ ﻰﻟﺇ
ﻡﺎـﻌﻁﻟﺍ ﺢﻠﻤ لﻭﻠﺤﻤ ﻥﻤ ﺔﻴﻭﺎﺴﻤ ﺔﻴﻤﻜ ﻯﺭﺨﻷﺍ ﺔﻋﻭﻤﺠﻤﻟﺍﻭ ﺩﻴﺭﻭﻟﺎﺒ ﻡﺎﻌﻁ ﺢﻠﻤ لﻭﻠﺤﻤ ﻥﻤ لﻤ
.ﺔﻘﻴﻗﺩ ﻥﻴﺭﺸﻋ لﻼﺨ
ﻉﺎﻓﺩـﻨﻻﺍ ل ﺩـﻌﻤﻭ ﻥﻴﺠﺴـﻜﻭﻷﺍ ﻊﺒﺸﺘ لﺩﻌﻤ،ﺱﻔﻨﺘﻟﺍ ﺕﺎﻤﻼﻋ ،ﺔﻴﻭﻴﺤﻟﺍ ﺕﺎﻤﻼﻌﻟﺍ ﺕﺫﺨﺁ
ﺩـﻨﻋ ﻭ 90، 60 ، 30 ﺔـﻘﻴﻗﺩﻟﺍ ﺩﻌﺒ ﻡﺜ ﻡﻭﻴﺯﻴﻨﻏﺎﻤﻟﺍ ﺕﺎﻔﻠﺴ ﺀﺎﻁﻋﺇ ﺩﻌﺒﻭ لﺒﻗ ﻲﻠﻋﻷﺍ ﻯﺭﻴﻓﺯﻟﺍ
.120 ﺔﻘﻴﻗﺩﻟﺍ
ﺕﺭـﻬﻅﺃ 30 ﺔـﻘﻴﻗﺩﻟﺍ ﺩﻨﻋ ﻥﻜﻟ ﺔﺴﺍﺭﺩﻟﺍ ﺔﻴﺍﺩﺒ ﺩﻨﻋ ﺔﻠﺜﺎﻤﻤ ﺞﺌﺎﺘﻨ ﺎﺘﺭﻬﻅﺃ ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ
:ﻲﺘﻵﺎﻜ ﺕﺎﻤﻼﻌﻟﺍ ﺕﻨﺎﻜ ﺙﻴﺤ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻥﻤ لﻀﻓﺍ ﻥﺴﺤﺘ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ
120 ﻰـﻟﺇ 90 ) ﻥﻴـﺒ ﻲـﻠﻋﻷﺍ ﻯﺭـﻴﻓﺯﻟﺍ ﻉﺎﻓﺩـﻨﻻﺍ لﺩﻌﻤﻭ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﺩﻨﻋ
ﺔـﻴﺭﺎﺒﺘﻋ ﻻﺍ ﺔﻤﻴﻘﻟﺍ ﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﺩﻨﻋ (ﺔﻘﻴﻗﺩﻟﺍ/ ﺭﺘﻟ 150 ﻰﻟﺇ 75) ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ (ﺔﻘﻴﻗﺩﻟﺍ/ﺭﺘﻟ
ﺭﺎـﺒﺘﺨﻻﺍ ﺔـﻋﻭﻤﺠﻤ ﻲـﻓ ﺔﻘﻴﻗﺩﻟﺍ/ ﺱﻔﻨ 61 ﻰﻟﺇ 39 ﻥﻴﺒ ﺡﻭﺍﺭﺘ ﺱﻔﻨﺘﻟﺍ لﺩﻌﻤﻭ P<O.O15
(P<0.024) ﺔـﻴﺭﺎﺒﺘﻋﻻﺍ ﺔـﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ ﺔﻘﻴﻗﺩﻟﺍ/ ﺱﻔﻨ 65 ﻰﻟﺇ 38 ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ
108 ﻊـﻤ ﺔـﻨﺭﺎﻘﻤﻟﺎﺒ ﺔﻘﻴﻗﺩﻟﺍ/ ﺔﻀﺒﻨ 135 ﻰﻟﺇ 102 ﻥﻤ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﺩﻨﻋ ﺽﺒﻨﻟﺍ لﺩﻌﻤﻭ.
(P<0.022) ﺔﻴﺭﺎﺒﺘﻋﻻﺍ ﺔﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ 154ﻰﻟﺇ
ﻊ ـﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﻡﻬﻨﻤ 29 ﻅﺤﻭﻟ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ ﺔﻴﻓﺎﻀﻹﺍ ﺱﻔﻨﺘﻟﺍ ﺕﻼﻀﻋ ﻡﺍﺩﺨﺘﺴﺍﻭ
(P<0.024) ﺔﻴﺭﺎﺒﺘﻋﻻﺍ ﺔﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ 32
ﻡﻜﺤﺘـﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﺭﺒﻜﺍ ﻥﺴﺤﺘ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﺕﺭﻬﻅﺃ 60 ﺔﻘﻴﻗﺩﻟﺍ ﺩﻨﻋ
ﻲﻠﻋﻷﺍ ﻯﺭﻴﻓﺯﻟﺍ ﻉﺎﻓﺩﻨﻻﺍ لﺩﻌﻤ ﻭ ﻥﻴﺠﺴﻜﻭﻷﺍ ﻊﺒﺸﺘ لﺩﻌﻤ ، ﺔﻴﻭﻴﺤﻟﺍ ﺕﺎﻤﻼﻌﻟﺍ ﻥﻤ لﻜ ﻲﻓ
. 120ﻭ 90 ﺔﻘﻴﻗﺩﻟﺍ لﻼﺨ ﺭﺜﻜﺍ ﺩﺍﺩﺯﺍ لﺒ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﻰﻠﻋ ﻥﺴﺤﺘﻟﺍ ﺍﺫﻫ ﺭﻤﺘﺴﺍ
140 ﻥﻤ ﻲﻠﻋﻷﺍ ﻯﺭﻴﻓﺯﻟﺍ ﻉﺎﻓﺩﻨﻻﺍ لﺩﻌﻤ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﺕﺭﻬﻅﺃ 120 ﺔﻘﻴﻗﺩﻟﺍ ﺩﻨﻌﻓ
ﺔـﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘـﻟﺍ ﺔـﻋﻭﻤﺠﻤ ﺩﻨﻋ ﺔﻘﻴﻗﺩﻟﺍ/ﺭﺘﻟ 160 ﻰﻟﺇ 80 ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﺔﻘﻴﻗﺩﻟﺍ/ ﺭﺘﻟ 330 ﻰﻟﺇ
ﻲـﻓ ﺔـﻘﻴﻗﺩﻟﺍ/ ﺱـﻔﻨ 43 ﻰـﻟﺇ ٢٠ ﻥﻴﺒ ﺎﻤ ﺡﻭﺍﺭﺘ ﺱﻔﻨﺘﻟﺍ لﺩﻌﻤﻭ (P<0.0001 ) ﺔﻴﺭﺎﺒﺘﻋﻻﺍ
ﺔﻴﺭﺎﺒﺘﻋﻻﺍ ﺔﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ ﺔﻘﻴﻗﺩﻟﺍ/ ﺱﻔﻨ 65 ﻰﻟﺇ 34 ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ
ﺔﻘﻴﻗﺩﻟﺍ/ ﺔﻀﺒﻨ 131 ﻰﻟﺇ 81 ﻥﻴﺒ ﺎﻤ ﺡﻭﺍﺭﺘ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﺩﻨﻋ ﺽﺒﻨﻟﺍ لﺩﻌﻤﻭ (P<0.001)
ﺔـﻴﺭﺎﺒﺘﻋﻻﺍ ﺔـﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘـﻟﺍ ﺔـﻋﻭﻤﺠﻤ ﻲـﻓ ﺔـﻘﻴﻗﺩﻟﺍ/ ﺔﻀﺒﻨ 152 ﻰﻟﺇ 96 ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ
ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﺩﻨﻋ 99% ﻰﻟﺇ 84 ﻥﻴﺒ ﺎﻤ ﺡﻭﺍﺭﺘ ﻥﻴﺠﺴﻜﻭﻷﺍ ﻊﺒﺸﺘ لﺩﻌﻤ . (P<0.001)
(P<0.0001) ﺔﻴﺭﺎﺒﺘﻋﻻﺍ ﺔﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ 98% ﻲﻟﺇ 85 ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ
ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﻡﻬﻨﻤ 3 ﻲﻓ ﺭﺎﺒﺘﺨﻻﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ ﻅﺤﻭﻟ ﺔﻴﻓﺎﻀﻹﺍ ﺱﻔﻨﺘﻟﺍ ﺕﻼﻀﻋ ﻡﺍﺩﺨﺘﺴﺍﻭ
(P<0.001) ﺔﻴﺭﺎﺒﺘﻋﻻﺍ ﺔﻤﻴﻘﻟﺍﻭ ﻡﻜﺤﺘﻟﺍ ﺔﻋﻭﻤﺠﻤ ﻲﻓ 32 ﻊﻤ
. ﻱﺩﻴﺭﻭﻟﺍ ﻡﻭﻴﺯﻴﻨﻏﺎﻤﻟﺍ ﺕﺎﻔﻠﺴ ﺭﺎﻘﻋ ﻡﺍﺩﺨﺘﺴﺍ ﺔﺠﻴﺘﻨ ﺔﻴﺒﻨﺎﺠ ﺭﺎﺜﺁ ﻱﺃ ﺙﺩﺤﺘ ﻡﻟ
ﺭـﻁﺨﻟﺍ ﺩﺎـﺤﻟﺍ ﻭﺒﺭﻟﺍ ﺕﻻﺎﺤ ﺝﻼﻌﻟ ﻱﺩﻴﺭﻭﻟﺍ ﻡﻭﻴﺯﻴﻨﻏﺎﻤﻟﺍ ﺕﺎﻔﻠﺴ ﻡﺍﺩﺨﺘﺴﺍ ﻥﺇ : ﺔﻤﺘﺎﺨﻟﺍ
.ﺭﻜﺫﺘ ﺔﻴﺒﻨﺎﺠ ﺭﺎﺜﺁ ﻥﻭﺩ ﺔﻌﻴﺭﺴ ﺔﺒﺎﺠﺘﺴﺍ ﻲﻟﺇ ﺕﺩﺁ لﺎﻔﻁﻻﺍ ﺩﻨﻋ
LIST OF TABLES

Page
Table (1): Distribution of the study group according to
weight percentile 58
Table (2): Distribution of the study group according to height
percentile 59
Table (3): Exercise tolerance (playing games) of the study 60
group
Table (4): Pulsus Paradoxus of the study group at zero time 61
Table (5): Pulsus Paradoxus of the study group at 30 min 62
Table (6): Pulsus Paradoxus of the study group at 60 min 63
Table (7): Pulsus Paradoxus of the study group at 90 min 64
Table (8): Pulsus Paradoxus of the study group at 120 min 65
Table (9): Accessory muscle use of the test and control group
at 60 min 66
Table (10): Accessory muscle use of the test and control group
at 90 min 67
Table (11): Accessory muscle use of the test and control group
at 120 min 68
LIST OF FIGURES

Page
Figure (1) Distribution of cases of asthma according to age. 69
Figure (2) Distribution of cases of asthma according to gender. 70
Figure (3) The presenting symptoms of the study group. 71
Figure (4) Distribution of cases according to age of first presentation 72
with wheezes.
Figure (5) Distribution of cases according to number of admissions to 73
casualty.
Figure (6) Distribution of cases according to number of life 74
threatening attacks
Figure (7) History of eczema among the study group 75
Figure (8) History of allergic rhinitis among the study group. 76
Figure (9) Distribution of cases according to family history of a topy 77
Figure (10) Factors known to precipitate attacks of asthma in the 78
study group.
Figure (11) Drugs used at home by the study group 79
Figure (12) Distribution of the presenting signs in the study group 80
Figure(13) PEFR of the test and control group at zero time 81
Figure(14) PEFR of the test and control group at 30 min 82
Figure(15) PEFR of the test and control group at 60 min 83
Figure(16) PEFR of the test and control group at 90 min 84
Figure(17) PEFR of the test and control group at 120 min 85
Figure (18) Percentage of Oxygen saturation of the test and control 86
group at zero time
Figure (19) Percentage of Oxygen saturation of the test and control 87
group at 30 min
Figure (20) Percentage of Oxygen saturation of the test and control 88
group at 60 min
Figure (21) Percentage of Oxygen saturation of the test and control 89
group at 90 min
Figure (22) Percentage of Oxygen saturation of the test and control 90
group at 120
Figure (23) Respiratory rate of the test and control group at zero time 91
Figure (24) Respiratory rate of the test and control group at 30 min. 92
Figure (25) Respiratory rate of the test and control group at 60 min. 93
Figure (26) Respiratory rate of the test and control group at 90 min. 94
Figure (27) Respiratory rate of the test and control group at 120 min. 95
Figure (28): heart rate of the test and control group at zero time. 96
Figure (29): heart rate of the test and control group at 30 min. 97
Figure (30): heart rate of the test and control group at 60 min. 98
Figure (31): heart rate of the test and control group at 90 min. 99
Figure (32): heart rate of the test and control group at 120 min. 100