0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Serum Magnesium Levels in Asthmatic Children During and Between Exacerbations FREE

Khalid S. Kakish, MD
[+] Author Affiliations

From the Department of Pediatrics, Jordan University of Science and Technology, Irbid.


Arch Pediatr Adolesc Med. 2001;155(2):181-183. doi:10.1001/archpedi.155.2.181.
Text Size: A A A
Published online

Objective  To determine, if possible, whether magnesium deficiency exists in children with asthma during acute attacks and between exacerbations.

Setting  Emergency Department Clinic and Outpatient Pediatric Clinic of Jordan University of Science and Technology, Irbid.

Methods  A total of 174 known asthmatic children who presented to the emergency department in acute attack (group 1) and 94 asthmatic children who presented to outpatient clinics for follow-up of asthma (group 2) had their serum magnesium levels assayed and compared with 232 patients without asthma (controls; group 3). Exclusion criteria were history of renal disease, cardiac disease, malabsorption, diuretic use, alcoholism, and pregnancy.

Results  There were no differences between study groups, although male patients had a slightly lower level of magnesium than female patients.

Conclusion  After removing the confounder of sex, serum magnesium levels in asthmatic children during acute attacks and between exacerbations are not significantly different from those of controls.

MAGNESIUM is the fourth most abundant cation in the body and the second most common intracellular cation. Since magnesium intervenes in calcium transport mechanisms and intracellular phosphorylation reactions, it constitutes an important determinant of the contraction and relaxation state of bronchial smooth muscle.1 Magnesium deficiency is associated with increased contractility of smooth muscle cells.2 Since contractility of bronchial smooth muscle is important in patients with asthma, magnesium deficiency could lead to bronchial smooth muscle contraction or lack of bronchial muscle relaxation.2

Haury3 reported significantly lower levels of serum magnesium in asthmatic adults compared with the general population. In this study, cases were compared with healthy medical students. Other case-control studies2,4 conducted on asthmatic adults failed to demonstrate a significant difference in serum magnesium between patients with asthma and controls. Several clinical trials57 reported a beneficial response of pulmonary function tests to intravenous infusion of magnesium sulfate in the treatment of acute exacerbation of asthma. Although clinical trials8,9 using magnesium as an adjunct to treating asthma exacerbation have been conducted in children, no work has yet been done to determine whether serum magnesium levels in asthmatic children differ from those of controls and whether asthma exacerbation in children is associated with low serum magnesium levels. Therefore, we undertook this study to assess whether magnesium deficiency exists in asthmatic children between attacks and during exacerbations.

This study was conducted from June through December 1999. Patients between the ages of 6 and 18 years who presented to the emergency department with acute exacerbation of asthma (group 1) and those who presented to outpatient pediatric clinics for follow-up of asthma (>6 weeks after the last attack) (group 2) were entered into our study as long as the asthma diagnosis was made by a physician based on the criteria set by the Expert Panel Report 2.10 A sample of blood was drawn through a standard venipuncture technique and analyzed for a serum magnesium level, using spectrophotometry and calorimetric determination based on the reaction of calmagite at pH of 11 and wavelength of 520 nm (bioMerieux Vitek Inc, St Louis, Mo). Normal reference values for serum magnesium ranged from 0.66 to 1.05 mmol/L (1.60 to 2.55 mg/dL) in our laboratory. For each asthmatic patient enrolled in the study, the next available patient who visited the outpatient pediatric clinic or emergency department for reasons other than asthma was enrolled as a control, provided he/she met our admission criteria. Serum magnesium levels were also analyzed for this randomly chosen control group of nonasthmatic children (group 3) as they presented to the emergency department and the outpatient clinics for other reasons.

All determinations were made in duplicate. Informed consent was obtained from the parents or legally authorized representatives. Peak expiratory flow rate using a flowmeter (True Zone Peak Flow Meter; Trudell Medical, Quebec, Canada), respiratory rate, air exchange, wheezing, and speech production were recorded for all asthmatic children in exacerbation to assess the severity of the acute attack according to the guidelines set by the Expert Panel Report 2.10 Further data were also collected on the asthmatic groups of children, including the regular use and type of medication and the number of times they received oral corticosteroids during the last year. Data collected on all 3 study groups of children included sex, number of schooling years completed by parents, total monthly income of the family, and place of residence. Exclusion criteria for the 3 study groups included a history of renal disease, cardiac disease, malabsorption, diuretic use, alcoholism, and pregnancy.

Data were entered and analyzed using Epi Info version 6 software (Centers for Disease Control and Prevention, Atlanta, Ga). The 3 study groups were compared regarding a number of sociodemographic characteristics. Observed differences were assessed for statistical significance using the χ2 test. The 2-sample t test was used to assess the statistical difference between 2 means, and analysis of variance was used to assess the statistical significance between more than 2 means. Multivariate linear regression was used to assess for the difference in serum magnesium levels among the 3 study groups while adjusting for sex, the only variable that was significantly different among the 3 groups.

A total of 275 asthmatic children and 245 controls were entered into the study. Of the asthmatic group, 7 were excluded for not meeting the diagnostic criteria of asthma. Thirteen of the controls were excluded for having a history of renal disease and malabsorption. Of the 268 asthmatic patients enrolled, 174 presented in acute exacerbation (group 1) and 94 presented between exacerbations (group 2).

There were no differences between the study groups for age, parental education, place of residence, and monthly income. However, there was a statistically significant difference for sex (P = .008). Serum magnesium levels were significantly lower among group 2 than the other 2 groups (Table 1). The influence of several patients' characteristics (the regular use of inhaled corticosteroids, the number of oral courses of prednisolone, the age groups of studied population, the parents' education, the place of residence, and the total monthly income of the family) on the serum magnesium level was examined consecutively and showed no significant correlation. When the relation between sex and serum magnesium level was examined, male patients had significantly lower levels of serum magnesium than female patients (0.91 ± 0.14 mmol/L [2.21 ± 0.33 mg/dL] vs 0.94 ± 0.14 mmol/L [2.28 ± 0.33], P = .03). Among the group of children with acute asthma exacerbation, 75 had mild attacks, 67 had moderate attacks, and 32 had severe attacks.

Table Graphic Jump LocationSerum Magnesium Levels Among the 3 Study Groups

A comparison of the mean magnesium levels in each respective group revealed no significant correlation between magnesium levels and pulmonary function test results.

Because the 3 study groups of children were significantly different only in regard to sex and magnesium levels (which were significantly lower among male patients), we adjusted serum magnesium levels for sex using multivariate linear regression.

The observed differences in serum magnesium levels among the 3 study groups lost their statistical significance after removing the confounding effect of sex.

It is not clear whether magnesium deficiency plays a role in the development of asthma, but magnesium salts have a therapeutic role as an adjunct to traditional therapy of asthma.11 One previous study3 reported concomitant hypomagnesemia in adults with bronchial asthma. Findings from our study demonstrated that serum magnesium levels in asthmatic children during and between exacerbations are not significantly different from those of a control group. This is consistent with findings from studies conducted on adults with asthma.2,4,6 Our study found no observed correlation between serum magnesium levels and the severity of asthma attack, consistent with results from a published study conducted in adults.4 Since all 3 study groups had serum magnesium levels generally within the normal range, serum magnesium levels are not useful for characterizing the severity of the disease or the disease exacerbation. Serum magnesium levels are also not predictive of the need for or response to magnesium infusion as an adjunct to treatment in the emergency department.

Although intravenous administration of magnesium sulfate to outpatients with asthma led to improvement in pulmonary function tests,6,12 the results of our study suggest that factors other than serum magnesium level could play a role in determining the severity of an attack, the degree of response to standard therapy, and, finally, the need for and benefit of magnesium sulfate.

No relation was found between the regular use of inhaled corticosteroids and serum magnesium level, contrary to the findings from a published study2 that demonstrated a small, but statistically significant, decrease in serum magnesium levels. This could be partially explained by the lower dose of corticosteroids given to children compared with adults. The relation we found between sex and serum magnesium levels has not been described previously. To my knowledge, there is no physiologic basis to suspect a sex difference in magnesium levels, since laboratory standards for magnesium have not been demonstrated to be sex specific.

In conclusion, we found no evidence for the existence of decreased magnesium level in children with asthma. These data suggest that serum magnesium level determination plays no useful role in the evaluation and management of asthmatic children during and between exacerbations.

Accepted for publication October 17, 2000.

Corresponding author and reprints: Khalid S. Kakish, MD, Department of Pediatrics, Jordan Universityof Science and Technology, PO Box 3030, Irbid, Jordan 22110 (e-mail: kakish@just.edu.jo).

Dominguez  LJBarbagallo  MDi Lorenzo  G  et al.  Bronchial reactivity and intracellular magnesium: a possible mechanism for the bronchodilating effects of magnesium in asthma. Clin Sci (Colch). 1998;95137- 142
Link to Article
de Valk  HWKok  PTStruyvenberg  A  et al.  Extracellular and intracellular magnesium concentrations in asthmatic patients. Eur Respir J. 1993;61122- 1125
Haury  VG Blood serum magnesium in bronchial asthma and its treatment by the administration of magnesium sulfate. J Lab Clin Med. 1940;26340- 344
Falkner  DGlauser  JAllen  M Serum magnesium levels in asthmatic patients during acute exacerbations of asthma. Am J Emerg Med. 1992;101- 3
Link to Article
Skobeloff  ESpivey  WMcNamara  R  et al.  Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA. 1989;2621210- 1213
Link to Article
Rolla  GBucca  CCaria  E  et al.  Acute effect of intravenous magnesium sulfate on airway obstruction of asthmatic patients. Ann Allergy. 1988;61388- 391
Noppen  NVanmaele  LImpens  N  et al.  Bronchodilating effect of intravenous magnesium sulfate in acute severe bronchial asthma. Chest. 1990;97373- 376
Link to Article
Clark  MCWright  GDFalk  JL  et al.  Aerosolized magnesium sulfate as acute therapy for pediatric asthma. Ann Emerg Med. 1991;20448
Pabon  HMonem  GKissoon  N Safety and efficacy of magnesium sulfate infusion in children with status asthmaticus. Pediatr Emerg Care. 1994;10200- 203
Link to Article
National Heart, Lung, and Blood Institute, Clinical Practice Guidelines: Guidelines for the Diagnosis and Management of Asthma.  Bethesda, Md National Institutes of Health1997;Publication 97-4051
Mathew  RAltura  BM The role of magnesium in lung disease: asthma, allergy and pulmonary hypertension. Magnes Trace Elements. 1991;92;10 (2-4) 220- 228
Keinhart  KA Magnesium metabolism. Arch Intern Med. 1988;482415- 2420

Figures

Tables

Table Graphic Jump LocationSerum Magnesium Levels Among the 3 Study Groups

References

Dominguez  LJBarbagallo  MDi Lorenzo  G  et al.  Bronchial reactivity and intracellular magnesium: a possible mechanism for the bronchodilating effects of magnesium in asthma. Clin Sci (Colch). 1998;95137- 142
Link to Article
de Valk  HWKok  PTStruyvenberg  A  et al.  Extracellular and intracellular magnesium concentrations in asthmatic patients. Eur Respir J. 1993;61122- 1125
Haury  VG Blood serum magnesium in bronchial asthma and its treatment by the administration of magnesium sulfate. J Lab Clin Med. 1940;26340- 344
Falkner  DGlauser  JAllen  M Serum magnesium levels in asthmatic patients during acute exacerbations of asthma. Am J Emerg Med. 1992;101- 3
Link to Article
Skobeloff  ESpivey  WMcNamara  R  et al.  Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA. 1989;2621210- 1213
Link to Article
Rolla  GBucca  CCaria  E  et al.  Acute effect of intravenous magnesium sulfate on airway obstruction of asthmatic patients. Ann Allergy. 1988;61388- 391
Noppen  NVanmaele  LImpens  N  et al.  Bronchodilating effect of intravenous magnesium sulfate in acute severe bronchial asthma. Chest. 1990;97373- 376
Link to Article
Clark  MCWright  GDFalk  JL  et al.  Aerosolized magnesium sulfate as acute therapy for pediatric asthma. Ann Emerg Med. 1991;20448
Pabon  HMonem  GKissoon  N Safety and efficacy of magnesium sulfate infusion in children with status asthmaticus. Pediatr Emerg Care. 1994;10200- 203
Link to Article
National Heart, Lung, and Blood Institute, Clinical Practice Guidelines: Guidelines for the Diagnosis and Management of Asthma.  Bethesda, Md National Institutes of Health1997;Publication 97-4051
Mathew  RAltura  BM The role of magnesium in lung disease: asthma, allergy and pulmonary hypertension. Magnes Trace Elements. 1991;92;10 (2-4) 220- 228
Keinhart  KA Magnesium metabolism. Arch Intern Med. 1988;482415- 2420

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 4

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Diet and obstructive lung diseases. Epidemiol Rev 2001;23(2):268-87.