ABSTRACT
BACKGROUND: Magnesium sulfate (MgSO4) is widely used in analgesia for different conditions. Recent randomized controlled trials (RCTs) have evaluated the effects of MgSO4 on renal colic; however, this new evidence has not been synthesized. Thus, we conducted a systematic review and meta-analysis to assess the efficacy and safety of MgSO4 in comparison with control for renal colic. METHODS: PubMed, EMBASE, and Scopus databases were searched from inception to February 2020. We included RCTs that evaluated MgSO4 vs control for patients with renal colic. Data were independently extracted by 2 reviewers and synthesized using a random-effects model. RESULTS: Four studies with a total of 373 patients were analyzed. Intravenous MgSO4 15 to 50âmg/kg did not significantly reduce renal colic pain severity at 15âminutes (mean difference [MD]â=â0.35, 95% confidence interval [CI] -0.51 to 1.21; 2 RCTs), 30âminutes (MDâ=â0.19, 95% CI -0.74 to 1.13; 4 RCTs), and 60âminutes (MDâ=â-0.28, 95% CI -0.72 to 0.16; 3 RCTs) in comparison with controls. In patients who failed to respond to initial analgesics, intravenous MgSO4 15âmg/kg or 2âml of 50% solution provided similar pain relief to ketorolac or morphine at 30âminutes (Pâ=â.90) and 60âminutes (Pâ=â.57). No significant hemodynamic changes were observed with short-term use of MgSO4 in these studies. CONCLUSION: MgSO4 provides no superior therapeutic benefits in comparison with control treatments. MgSO4 may be used as a rescue medication in patients not responding to initial analgesics. The short-term use of MgSO4 did not affect hemodynamic values.
Subject(s)
Magnesium Sulfate/standards , Pain Management/standards , Renal Colic/drug therapy , Analgesics/pharmacology , Analgesics/standards , Analgesics/therapeutic use , Humans , Magnesium Sulfate/pharmacology , Magnesium Sulfate/therapeutic use , Pain Management/methods , Pain Management/statistics & numerical dataSubject(s)
Acute Pain/etiology , Genital Diseases, Male/diagnosis , Scrotum/diagnostic imaging , Spermatic Cord Torsion/diagnosis , Genital Diseases, Male/pathology , Humans , Male , Orchiopexy/methods , Scrotum/blood supply , Scrotum/pathology , Spermatic Cord Torsion/prevention & control , Spermatic Cord Torsion/therapy , Treatment Outcome , Ultrasonography/methods , Young AdultABSTRACT
Harlequin syndrome is rare and typically characterized by asymmetric flushing and sweating. Although it is usually considered idiopathic, literature review shows that it may be caused by lesion over lung apex or after central venous catheterization in the internal jugular vein. We present a 74-year-old woman who had been experiencing recurrent chest pain and right shoulder pain since 2 weeks ago. The tentative diagnosis was made by the emergency physician (EP) as acute coronary syndrome. The patient was given nitroglycerin treatment. Twelve hours later, the patient developed another episode of chest pain. The electrocardiogram and cardiac enzyme study results were, however, both normal. Further evaluation showed intermittent flushing over the left side of her face, as well as right-eye ptosis. A chest computed tomography (CT) was conducted, under the suspicion of Harlequin syndrome in combination with Horner syndrome, to derive the diagnosis of a right lung apex tumor. This case showed that history taking and physical examination are very important in the emergency department. It is particularly vital to observe the microchanges in the patient's symptoms and signs. It is also imperative to reassess the patient whose symptoms fail to improve under treatment, to look for other underlying lesions.