Magnesium Sulfate in Pediatric Emergency Medicine: Pharmacology, Evidence, and Clinical Applications

Magnesium sulfate (MgSO₄) is a well-established therapeutic agent with extensive historical use, predominantly recognized in obstetrics. However, its critical role in pediatric emergency care remains underrecognized despite substantial clinical evidence supporting its efficacy in severe asthma exacerbations, refractory seizures, and life-threatening cardiac arrhythmias. This review aims to consolidate and critically appraise the current evidence regarding MgSO₄ pharmacologic mechanisms, clinical applications, and therapeutic impact across major pediatric emergencies, emphasizing the potential to improve morbidity and mortality outcomes through optimized utilization. A comprehensive literature synthesis was conducted, integrating mechanistic insights with clinical trial data and guideline recommendations pertaining to MgSO₄ use in pediatric seizures, status asthmaticus, and cardiac emergencies. Emerging trends, dosing strategies, safety profiles, and comparative effectiveness were analyzed to delineate best practices. MgSO₄ demonstrates distinct electrophysiological and anti-inflammatory properties, contributing to its neuroprotective, bronchodilatory, and antiarrhythmic effects in children. Rigorous clinical evidence supports MgSO₄ as a vital adjunct in refractory status epilepticus, severe asthma not responsive to first-line therapies, and torsades de pointes or certain bradyarrhythmias. Despite these benefits, substantial disparities in clinical adoption persist globally, often due to limited awareness, protocol variability, and concerns about dosing and adverse effects. MgSO₄ represents a powerful, multi-dimensional pharmacologic agent that is critically underutilized in pediatric emergency medicine. Standardized global protocols integrating MgSO₄ could markedly enhance outcomes in seizure management, critical asthma exacerbations, and cardiac arrhythmias. This synthesis advocates for reemphasizing MgSO₄ as a first-line or adjunctive intervention in relevant pediatric emergency scenarios and supports further high-quality research to refine evidence-based guidelines.