From the Acute Stroke Unit, University Department of Medicine and
Therapeutics, Western Infirmary, Glasgow, Scotland.
Correspondence to Dr Keith W. Muir, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, Scotland. E-mail k.r.lees@clinmed.gla.ac.uk or k.muir{at}clinmed.gk.ac.uk
Background and
Purpose—Parenterally administered
MgSO4 is neuroprotective in standard animal models of focal
cerebral ischemia and in many other paradigms of brain injury.
Previous small clinical trials in stroke patients have explored the
safety and tolerability of different infusion regimens. This study was
undertaken to optimize the regimen for a multicenter trial.
Methods— Within 24 hours of the onset of clinically diagnosed
stroke, patients were randomized to receive placebo or one of three
intravenous MgSO4 infusions: a loading infusion
of 8, 12, or 16 mmol, followed by 65 mmol over 24 hours.
Cardiovascular parameters, serum magnesium
concentrations, and blood glucose concentrations were determined.
Outcome at 30 and 90 days was recorded.
Results—Twenty-five patients were recruited and treated at a mean
time of 20 hours after stroke. No tolerability problems were
identified. No effects of magnesium on heart rate, blood pressure, or
blood glucose were evident. Serum magnesium concentrations rose to
target levels most rapidly in the highest loading infusion group and
were maintained in all groups for at least 24 hours.
Conclusions—MgSO4 infusions that rapidly elevate the
serum magnesium concentration to potentially therapeutic levels are
well tolerated and have no major hemodynamic effects in
patients with acute stroke. The 16-mmol loading infusion achieved
target serum concentrations most rapidly and has been chosen for
further trials.
© 1998 American Heart Association, Inc.
Original Contributions
Dose Optimization of Intravenous Magnesium Sulfate After Acute Stroke
Key Words: clinical trials • randomized controlled trials • neuroprotection • magnesium
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