Efficacy of High-Dose Continuous Intravenous Magnesium Sulfate Infusion vs Standard Intravenous Magnesium Sulfate Therapy in Status Asthmaticus in the ED

The goal of this clinical is to compare treatment outcomes between high dose continuous IV Magnesium and standard therapy in the management of acute exacerbation of asthma in the emergency department. Participants will random assign to either high dose continuous IV drip or standard infusion. Participants in the intervention group received high-dose 50% magnesium sulfate (MgSO4), consisting of 2 g + normal saline (NSS) 100 ml administered intravenously over 30 minutes, followed by MgSO4 6 g + NSS 350 ml infused over 3.5 hours (approximately 40-50 mg/kg/h). In contrast, participants in the control group received standard-dose 50% MgSO4, consisting of 2 g + NSS 100 ml administered intravenously over 30 minutes, followed by a NSS 350 ml infusion over 3.5 hours. Measurements include symptom severity, respiratory rate, oxygen saturation, and pulmonary function tests. Primary endpoints are ED stay length, hospital admission, and ED revisit within 48 hours post-discharge. Adverse events are documented.

Inclusion Criteria: * Adults aged ≥18 years with a known diagnosis of asthma, and * Presence of signs and symptoms consistent with acute asthma exacerbation, including dyspnea, tachypnea, respiratory distress, chest tightness, cough, or wheezing, and * Indication for administration of intravenous magnesium sulfate (MgSO4) Exclusion Criteria: * Patients requiring endotracheal intubation at the time of initial presentation * Hypermagnesemia (more than 2.5 mg/dL) * Known hypersensitivity to magnesium sulfate * Diagnosed or suspected myasthenia gravis or neuromuscular disease * Suspected infection meeting the criteria for patients under investigation (PUI) for coronavirus disease 2019 (COVID-19) * Suspected or confirmed pulmonary tuberculosis * inability to perform pulmonary function testing (spirometry or peak expiratory flow) * known case chronic kidney disease (eGFR \