MgSO₄: The ED's Secret Weapon for COPD?
Can magnesium sulfate truly rescue patients in acute COPD exacerbation?
This critical appraisal of a Cochrane Systematic Review (2022) —
11 RCTs, n=762 — reveals the truth behind IV MgSO₄:
from shorter LOS to no mortality benefit.
Infographic by: Dr Cheng Yung Ban (PPUM) & Dr Salha Mohd Fadil (PPUM)
Endorsed by: College of Emergency Physicians Malaysia
Key Insights: MgSO₄ in AECOPD
NO EVIDENCE of Difference
IV MgSO₄ vs Placebo shows no benefit in:
- NIV requirement
- Lung function
- O₂ saturation
- ICU admission
- Intubation
- Mortality
- Adverse events
Reference: Ni, H., Aye, S. Z., & Naing, C. (2022). Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2022(5), Article CD013506. https://doi.org/10.1002/14651858.CD013506.pub2
Beneficial as ADJUNCT
In refractory AECOPD (not responding to bronchodilators & steroids), IV MgSO₄ could:
- Reduce need for admission
- Shorten hospital LOS
- Improve patient dyspnea score
Reference: Ni, H., Aye, S. Z., & Naing, C. (2022). Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2022(5), Article CD013506. https://doi.org/10.1002/14651858.CD013506.pub2
Take Home Message
MgSO₄ MUST NOT replace standard of care in COPD
- GRADE evidence: low to very low
- Routine use not supported by guidelines
- Use may be justified in refractory AECOPD or resource-limited settings
Reference: Ni, H., Aye, S. Z., & Naing, C. (2022). Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2022(5), Article CD013506. https://doi.org/10.1002/14651858.CD013506.pub2
Share this evidence-based rescue guide with your ED team!