This is a prospective randomized pilot study that seeks to address the research question: In children with moderate-to-severe asthma, do intravenous magnesium infusions added to standard Pediatric intensive care unit (PICU)-level asthma care significantly decrease time from patient presentation until PICU discharge?

This study will be a double-blind, prospective randomized pilot study. Subjects will be randomized on a 1:1 basis to receive routine asthma care with or without a magnesium drip.

Inclusion Criteria:

• Age 2 years 0 days up to 20 years 364 days

• Clinical diagnosis of asthma including both of the following:

  • Attending physician's primary working diagnosis is status asthmaticus
  • Results of a modified International Study of Asthma and Allergies in Children (ISAAC) diagnostic questionnaire consistent with an asthma diagnosis

• Planned PICU admission for moderate-to-severe asthma exacerbation persisting despite standard first-tier therapy (systemic corticosteroids and at least a one-hour treatment with nebulized albuterol/ipratroprium or equivalent) as evidenced by an asthma score of 7 or greater

• IV access or equivalent

• Ability to understand and give informed consent/assent in English

Exclusion Criteria:

• Prior enrollment in this study
• Prior adverse reactions to magnesium
• Use of systemic corticosteroids or magnesium in preceding 2 weeks, or administered at a transferring facility more than 3 hours prior to enrollment
• Admission for inpatient asthma care in preceding 2 weeks
• Hemodynamic instability, impending respiratory failure or intubation
• Inability in children age 7 years or older to give assent due to a developmental delay or altered mental status
• Significant renal or cardiac disease
• Sickle cell anemia
• Significant, active non-asthma pulmonary disease