Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major driver of disease-related morbidity. Their prevention and treatment are a focus of COPD management. Antibiotics, corticosteroids, and nebulized bronchodilators are all given to patients with AECOPD, and while the supporting data aren't perfect, there's little debate surrounding their use. These medications are well known to most physicians; we're comfortable with their efficacy and aware of their side effects. They are nothing if not familiar.
Photo Credit: Conceptw/Dreamstime
What about magnesium (Mg), though? Apparently, in the ER it is part of the standard AECOPD cocktail. I would argue that Mg is familiar to most too; every internal medicine trainee in the United States is taught to infuse 2 g of Mg intravenously for any inpatient (ICU or otherwise) with a serum level < 2.0 mg/dL. In fact, "electrolyte protocols" are part of the order sets at most hospitals where I've worked. Mg is infused reflexively when it drops below certain levels.
I'm less familiar with using Mg in the setting of an AECOPD, though. A recent online post by an academic ER physician (Richard Pescatore, DO) urged cautionin this setting. He argues that too many in the ER are embracing the "Dutch Hypothesis" and treating
