The effect of magnesium on length of stay for pediatric sickle cell pain crisis

Objectives To determine the effect of intravenous (IV) magnesium sulfate on the length of stay (LOS) for children admitted with sickle cell pain crisis. Methods This was a single arm study, with historical controls. Hemoglobin SS or Hemoglobin Sβ° children admitted for pain crisis were eligible. Two sequential treatment protocols of IV magnesium sulfate were added to standard inpatient therapy of IV fluids, opioids, and nonsteroidal anti-inflammatory drugs. The initial 12 children received 40 mg/kg (maximum of 1.5 g) of IV magnesium in the emergency department (ED), and eight and 16 hours later. Seven subsequent children received 40 mg/kg (maximum of 2.5 g) of IV magnesium in the ED, and every eight hours for up to four inpatient days. The main outcome measure was LOS, measured in days. Differences in LOS were analyzed between the admission with magnesium, and the two previous admissions meeting the same criteria, using a Wilcoxon signed-rank test for nonparametric paired data. Results Nineteen children were enrolled. The results of the two protocols were combined for the analysis. A shorter LOS was found on study admissions (median LOS, 3.0 days compared with 5.0 and 4.0 days for the previous two admissions; p=0.006). Conclusions IV magnesium appears to decrease the LOS for children with sickle cell pain crisis.