Panuwat Srichaisawat, MD¹

Background: Intravenous magnesium sulfate (MgSO₄) is an effective adjunctive therapy for severe pediatric asthma exacerbations, but the optimal administration timing remains unclear.

Objective: To describe the clinical course and outcomes of children hospitalized with moderate to severe asthma exacerbations treated with intravenous MgSO₄, stratified by administration timing.

Materials and Methods: A retrospective descriptive case series was conducted at a single university hospital in Thailand between 2022 and 2024. Children aged 2 to 15 years receiving intravenous MgSO₄ were categorized into early (310 minutes or less from triage) and late (more than 310 minutes) groups. Outcomes included time to clinical improvement, oxygen therapy duration, length of hospital stay (LOS), and adverse events.

Results: Ten patients were included, with six patients in the early group and four patients in the late group. Patients in the early group showed a trend toward faster clinical improvement (range 3.5 to 6.0 versus 7.0 to 11.0 hours) and shorter duration of oxygen therapy (median 51.0 versus 94.5 hours) compared to the late group. LOS varied between groups (median 72.0 versus 107.0 hours). No mechanical ventilation or adverse events occurred.

Conclusion: Earlier administration of MgSO₄ appeared to be associated with faster symptom resolution and reduced oxygen requirements in the present case series. The therapy was safe and well-tolerated. However, results should be interpreted with caution due to the small sample size and retrospective design.

Received 24 October 2025 | Revised 2 February 2026 | Accepted 3 February 2026

DOI: 10.35755/jmedassocthai.2026.4.03756