Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of asthma in children and adolescents and bronchiolitis in infants and young children
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
Updated
Intravenous (IV) magnesium sulfate (as a single short infusion) should be used as second-line therapy for severe paediatric asthma exacerbations, and for moderate exacerbations not responsive to standard first-line therapy with inhaled/nebulized medicines (short-acting beta2 agonist (SABA) and ipratropium) and systemic corticosteroids in health care facilities.
Recommended in favor
Strong
Certainty of evidence
Low
Notes and Remarks
- Current evidence does not support the use of inhaled magnesium sulfate, and IM magnesium sulfate has not been studied in acute asthma exacerbations.
- Intravenous infusion of magnesium sulfate relaxes smooth muscle and may result in hypotension, a side-effect commonly seen with the use of IM magnesium sulfate in pregnant women.
- It is advised that magnesium sulfate should be diluted in a compatible solution and administered as a single IV infusion over 20 minutes.
- The most frequent dosing regime was 50 mg/kg of magnesium sulfate diluted in 100 mL normal saline with a maximum dose of 2 g administered over 20–30 minutes, although it has been suggested that higher doses up to 100 mg/kg and prolonged infusions may be beneficial life-threatening asthma.
- Regular blood pressure monitoring should be included in the routine observations of children receiving IV magnesium sulfate.