Magnesium sulfate in organophosphorus compound poisoning: A prospective open-label clinician-initiated intervention trial with historical controls

BACKGROUND: The addition of magnesium sulfate (MgSO(4)) to standard treatment has improved mortality and morbidity associated with organophosphorus compound (OPC) poisoning. We aimed to assess the effectiveness of adjunctive intravenous MgSO(4) (IV MgSO(4)) in poisoning from OPCs. METHODS: Forty-seven cases and 72 controls were recruited to this prospective open-label clinician-initiated intervention trial after admitting OPC poisoning. All patients received standard treatment for anticholinesterase poisoning, and oximes were not used. Cases were divided into two groups. Group A (22 patients) received IV MgSO(4) at 4 g/day in four divided doses (1 g every 6 h) on day 1. Group B (25 patients) received the same daily dose of IV MgSO(4) throughout the hospital stay. Group C (72 patients) represents historical controls who did not receive IV MgSO4. The primary outcome was inhospital mortality. The secondary outcomes included the development of intermediate syndrome (IMS), the requirement of mechanical ventilation (MV), duration of MV, and length of hospital stay. RESULTS: Baseline parameters in both groups were comparable. There is no statistically significant difference in mortality among three groups (Group A: 2/22, 9.1%; Group B: 5/25, 20% and Group C: 6/72, 8.3%). Results were similar for the development of IMS, the requirement of MV, length of MV, and duration of hospital stay. CONCLUSION: IV MgSO(4) did not result in better outcomes compared with standard care alone in OPC poisoning.