Washington University Emergency Medicine Journal Club– July 20th, 2023


You’re working a typical shift in TCC one when encounter Mr. B, a 63-year-old male with a history of hypertension, hyperlipidemia, and COPD. He presents with 3 days of gradually worsening shortness of breath and cough productive of white sputum. His shortness of breath has been minimally relieved by nebulized albuterol at home, but has continued to worsen in spite of its use. He has been compliant with his Spiriva and Advair. 

On arrival to the ED, his oxygen saturation was 86% and is now improved to 93% with 3 L of oxygen by nasal cannula (he is not on home oxygen). His lung sounds are diminished with some faint wheezes and he is not in any distress, but does become dyspneic when speaking. 

You order the patient albuterol/atrovent duonebs, oral steroids, and azithromycin for a presumed COPD exacerbation. His chest x-ray reveals hyper-expanded lungs with no consolidation or infiltrates and his ECG is non-ischemic. Labs are normal (aside from a chronically elevated bicarbonate level of 35) and his COVID test is negative. 

He has had some improvement in symptoms with treatment, but is still requiring supplemental oxygen. You place an admit order to medicine for further management and the medicine team calls and ask if you would given him some IV magnesium. While well aware of the benefits of IV magnesium in acute asthma exacerbations, you were not aware it was helpful for COPD. After ordering 2 grams of magnesium sulfate, you decide to check the literature and see for yourself…

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Article 1: Jahanian F, Khatir IG, Ahidashti HA, Amirifard S. The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial. Ethiop J Health Sci. 2021 Mar;31(2):267-274. doi: 10.4314/ejhs.v31i2.9. PMID: 34158778; PMCID: PMC8188071. Answer Key.

Article 2: Vafadar Moradi E, Pishbin E, Habibzadeh SR, Talebi Doluee M, Soltanifar A. The Adjunctive Effect of Intravenous Magnesium Sulfate in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Clinical Trial. Acad Emerg Med. 2021 Mar;28(3):359-362. doi: 10.1111/acem.14050. Epub 2020 Jul 7. PMID: 32542879. Answer Key.

Article 3: Ni H, Aye SZ, Naing C. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2022 May 26;5(5):CD013506. doi: 10.1002/14651858.CD013506.pub2. PMID: 35616126; PMCID: PMC9134202. Answer Key.

Article 4: Skorodin MS, Tenholder MF, Yetter B, Owen KA, Waller RF, Khandelwahl S, Maki K, Rohail T, D’Alfonso N. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med. 1995 Mar 13;155(5):496-500. PMID: 7864705. Answer Key.

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