EFFECT OF INTRAVENOUS MGSO4 REPLACEMENT ON FUNCTIONAL OUTCOME IN ACUTE ISCHEMIC STROKE
Main Article Content
Keywords
Critical Care, Ischemic Stroke, Magnesium Sulfate
Abstract
Objective: To assess the efficacy of MgSO4 on functional outcome of patients presenting with acute ischemic stroke
Study Design: Quasi-experimental study
Place and Duration: Intensive Care unit, Tertiary Care Hospital Peshawar, April 2022- September 2022.
Methods: Patients of either gender between 45-80 years, presenting within 24 hours with clinical features and CT/MRI findings of acute ischemic stroke were included in the study. Non-probability consecutive sampling technique was employed and participants were placed in Group M (received MgSO4) and Group P (received placebo). Demographic characteristics, Mg levels, NIHSS scoring at admission, discharge and after 01 month were recorded parameters.
Results: Total 110 participants having male to female ratio of 2.2:1 with a median (IQR) age of 61.5years (57-65) were included. Hypertension was most common comorbidity in 55 patients (50%). Median (IQR) serum Mg levels at the time of admission were comparable among groups. After 48 hours of treatment, serum Mg levels were significantly greater in Group M as compared to Group P. Assessment of functional outcome by using NIHSS among groups at the time of discharge revealed significant improvement in patients who received Mg as compared to placebo (p-value 0.041). After a period of 01 month, functional outcome using NIHSS revealed median (IQR) score of 09 (8-10) in Group M as compared to 10 (8.6-12) in Group P (p - 0.004).
Conclusion: Intravenous MgSO4 improves functional outcome in acute ischemic stroke patients at discharge and at follow up after 30 days.
References
2. Chugh C. Acute ischemic stroke: management approach. Indian J. Crit. Care Med. 2019 Jun;23(Suppl 2):S140. DOI: 10.5005/jp-journals-10071-23192
3. Khan MI, Khan JI, Ahmed SI, Ali S. Epidemiology of Stroke in A Developing Country [Pakistan]. LAP LAMBERT Academic Publishing; 2019 Jan.
4. Sherin A, Ul-Haq Z, Fazid S, Shah BH, Khattak MI, Nabi F. Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17. Pak. J. Med. Sci. 2020 Nov;36(7):1435..DOI: 10.12669/pjms.36.7.2824
5. Herpich F, Rincon F. Management of acute ischemic stroke. Crit. Care Med. 2020 Nov 1;48(11):1654-63. DOI: 10.1097/CCM.0000000000004597
6. Hasan TF, Hasan H, Kelley RE. Overview of acute ischemic stroke evaluation and management. J. Biomed. 2021 Oct 16;9(10):1486. DOI: 10.3390/biomedicines9101486
7. Goenka L, Satyanarayana CR, George M. Neuroprotective agents in acute ischemic stroke—a reality check. Biomed. Pharmacother. 2019 Jan 1;109:2539-47. DOI: 10.1016/j.biopha.2018.11.041
8. Sullivan M, Cunningham K, Angras K, Mackeen AD. Duration of postpartum Mg sulfate for seizure prophylaxis in women with preeclampsia: a systematic review and meta-analysis. J. Matern. -Fetal Neonatal Med. 2022 Dec 12;35(25):7188-93. DOI: 10.1080/14767058.2021.1946505
9. Afshari D, Moradian N, Rezaei M. Evaluation of the intravenous Mg sulfate effect in clinical improvement of patients with acute ischemic stroke. Clin Neurol Neurosurg. 2013;115:400–04. DOI: 10.1016/j.clineuro.2012.06.001
10. MOUSAVI S.A., ZIAEE J., SAADATNIA M.. MG SULFATE IN ACUTE STROKE: A RANDOMIZED DOUBLE-BLIND CLINICAL TRIAL. J Res Med Sci (JRMS) 2004;9(4):7-10.
11. Muir KW. Mg for neuroprotection in ischaemic stroke: rationale for use and evidence of effectiveness. CNS drugs. 2001 Dec;15:921-30. Doi: 10.2165/00023210-200115120-00002.
12. Botturi A, Ciappolino V, Delvecchio G, Boscutti A, Viscardi B, Brambilla P. The role and the effect of Mg in mental disorders: a systematic review. J. Nutr. 2020 Jun 3;12(6):1661. Doi:10.3390/nu12061661
13. Panahi Y, Mojtahedzadeh M, Najafi A, Gheini M, Abdollahi M, Sharifzadeh M et al. Protective Effects of Intravenous Mg Sulfate in Stroke Patients Receiving Amiodarone: A Randomized Controlled Trial. Pharmacological Properties of Plant-Derived Natural Products and Implications for Human Health. 2021:579-88.
14. Murphy SJ, Werring DJ. Stroke: causes and clinical features. J. Med. 2020 Sep 1;48(9):561-6. Doi:10.1016/j.mpmed.2020.06.002
15. Hollist M, Morgan L, Cabatbat R, Au K, Kirmani MF, Kirmani BF. Acute stroke management: overview and recent updates. Aging Dis. 2021 Jul;12(4):1000. Doi: 10.14336/AD.2021.0311
16. Avgerinos KI, Chatzisotiriou A, Haidich AB, Tsapas A, Lioutas VA. Intravenous Mg Sulfate in Acute Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Stroke Med. 2019 Apr;50(4):931-8. Doi:10.1161/STROKEAHA.118.021916
17. Ortiz JF, Ruxmohan S, Saxena A, Cox ÁM, Bashir F, Tambo W, Ghani MR, Moya G, Córdova I. Minocycline and Mg as neuroprotective agents for ischemic stroke: a systematic review. Cureus. 2020 Dec 28;12(12). DOI: 10.7759/cureus.12339
18. Cheng Z, Huang X, Muse FM, Lin X, Cao Y. Low serum Mg levels are associated with hemorrhagic transformation after thrombolysis in acute ischemic stroke. Front Neurol. 2020 Sep 2;11:567644. Doi: /10.3389/fneur.2020.00962
19. Pascoal AC, Katz L, Pinto MH, Santos CA, Braga LC, Maia SB, Amorim MM. Serum Mg levels during Mg sulfate infusion at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in women with severe preeclampsia: A randomized clinical trial. J. Med. 2019 Aug 1;98(32):e16779. DOI: 10.1097/MD.0000000000016779
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Gullali
Trainee Medicine, CMH, Peshawar - Pakistan
Dr. Maryam Hussain
MBBS, FCPS Medicine and Pulmonology, Medical Specialist and Pulmonologist, CMH, Peshawar - Pakistan
Dr. Wahaj Ul Hassan Khan
MBBS, FCPS Medicine and Neurology, Medical Specialist and Neurologist, CMH, Peshawar - Pakistan
Dr. Ayesha Laraib
Demonstrator Anatomy Department, Ayub Medical College, Abbottabad - Pakistan
Dr. Amjad Khan
Trainee Pulmonology, Fatima Jinnah Institute of Chest Diseases, Quetta - Pakistan
Dr. Naeem Ullah
Trainee Medicine, Khyber Teaching Hospital, Peshawar - Pakistan