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Skip to content Skip to search Skip to footer Emergency Medicine Open Menu Back Close Menu Search for: Search Close Search WelcomeWelcome Mission Clinical Sites Explore St. Louis Our TeamOur Team Leadership Division Chiefs Faculty Residency Administration Fellowship Administration Research Personnel APP DivisionsDivisions Critical Care Medicine EMS Toxicology Ultrasound EducationEducation Residency Simulation Fellowships Medical Students AlumniAlumni Giving Options ResearchResearch ECRCECRC Current Studies Researchers Research Fellowship Summer Research Program – EMERGE Journal ClubJournal Club Archive Tool Box News EventsEvents Emergency Medicine Event Calendar View Lewis Health Policy Symposia Code 3 Conference Jermyn Lectures Women in Medicine Symposium Guidelines for Patient Data Request Management EM Accounting Services EMIAA IV Magnesium for Acute COPD Exacerbations Publications Vanc/Zosyn and Kidney Injury IV Steroids for Prevention of Rebound Migraine Headache Ultra High Dose and IV Bolus Nitroglycerin for SCAPE Open Search IV Magnesium for Acute COPD Exacerbations Washington University Emergency Medicine Journal Club– July 20th, 2023 Vingnette: 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… PICO Question Population: Intervention: Comparison: Outcome: Search Strategy 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&＃8217;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. Bottom Line: Department of Emergency Medicine660 S. Euclid AveCampus Box 8072Saint Louis, MO 63110Phone: 314-747-4156 | Fax: [email protected] Instagram LocationsWashington University Barnes-Jewish Hospital St. Louis Children's Hospital Missouri Baptist Medical Center Barnes-Jewish West County Barnes-Jewish St. Peters ©2024 Washington University in St. Louis