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Elevation of serum magnesium may improve clinical outcome after aneursymal subarachnoid haemorrhage

Report by: Daniel Horner, ST4 Emergency Medicine/Critical Care

Search checked by: Craig Ferguson, SpR Emergency Medicine

Institution: Manchester Royal Infirmary, Manchester, UK

A short-cut review was carried out to establish whether treatment with intravenous magnesium would improve the clinical outcome after an aneurismal subarachnoid haemorrhage (SAH). Five papers including systematic reviews were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that prophylactic elevation of serum magnesium in aneurysmal SAH may improve outcome when given in addition to standard treatment.

Three-part question

In a patient presenting with [aneurysmal subarachnoid haemorrhage] does [early elevation of serum magnesium by administration of intravenous magnesium sulphate] lead to a reduction in [subsequent vasospasm incidence, morbidity or mortality rates]?

Clinical scenario

A 40-year-old woman attends the emergency department as a standby call. Her partner gives you a history of acute headache followed by collapse and reduced conscious level. She is rapidly intubated and …

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