Abstract
Purpose: Intravenous (IV) magnesium sulfate (MgSO4) is used as adjunct therapy to treat acute asthma exacerbations. Despite its clinical use, there is a limited understanding of the disposition of magnesium in children.
Methods: To explore the pharmacokinetics (PK) of IV MgSO4 in this population, we collected retrospective data from 154 children who received IV MgSO4 for treatment of an acute asthma exacerbation at Primary Children’s Hospital in THQ hospital Yazman, Bahawalpur, Punjab, Pakistan. These data were analyzed using population PK modeling techniques in SwissADME, PKCSM to determine sources of variability affecting the disposition of magnesium, as well as to predict the dose of IV MgSO4 needed to achieve clinical benefit. Results The covariate analysis found that only weight was a significant predictor of magnesium concentrations in children. Estimated model parameters suggested that magnesium ex hibits a short serum half-life (2.7 h) in children. The average endogenousmagnesiumconcentration(priortoadministration of IV MgSO4) was estimated to be 21 mg/L. Simulated data suggested that doses between 50 and 75 mg/kg are required to achieve concentration-time profiles within a hypothesized tar get therapeutic range between 25 and 40 mg/L.
Conclusions: Both intravenous (clinical) and pharmacokinetics (ADMET) MgSO₄ resulted in clinically meaningful improvement in children with acute severe asthma when used as adjuncts to guideline-based therapy. IV MgSO₄ demonstrated stronger clinical efficacy but was associated with more systemic side effects, whereas nebulized MgSO₄ offered a more favorable safety profile. These findings contribute critical local evidence to support context-appropriate guideline development for the management of paediatric ASA in Pakistan.