Mg in COPD

Q: In acute exacerbation of COPD, how much intravenous Magnesium (IV-Mg) is recommended?

A) 2 grams

B) 4 grams

C) 6 grams

Answer: A

Magnesium sulfate has shown a beneficial bronchodilator effect in acute exacerbation of COPD. It has an adjuvant value when short-acting inhaled bronchodilators are not or partially relieving the symptoms. The mechanism of action is the inhibition of calcium influx into airway smooth muscle cells. Usually, 2 grams of IV magnesium sulfate are given for over 20 minutes. 

Like digoxin in congestive heart failure (CHF), it is found to decrease hospitalizations in COPD exacerbations.

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References:

1. Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. J Aerosol Med 2001; 14:301.

2. Ni H, Aye SZ, Naing C. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 5:CD013506.

3. Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev 2014; :CD010909.