Loop diuretics and thiazides are mainstay of cardiac acute pulmonary edema treatment.these drugs lead to excretion of Mg in urine, that decreasing Mg in intra and extracellular fluids. in past trial reported depletion of Mg in intra and extracellular fluid by one month treatment of lasix or hydrochlorotiazid. and so Mg depletion leads to dysrhythmia, neuromuscular dysfunction, hypokalemia and hypocalcemia that resistance to treatment in CHF patient under treatment by diuresis. also MgSo4 infusion ( by depletion both catecholamine release and peripheral vascular resistance ) leads to both repletion and improving noncardiac pulmonary edema (in pheochromocytoma).It causes to improvement of respiratory failure and decreased intubation in severe asthma attack.in this trial,goal is whether that MgSo4 infusion in decreased hospitalization duration, decreased intubation, decreased dysrhythmia incidence that should be treat in ED, improvement both SaO2 and dyspnea score(verbal quantitative scale) in 6 hours after treatment initiation?
this trial is doing randomized single blind clinical trial.
pateints with acute cardiac pulmonary edema divided in 2 groups randomizely after that explained about trial and side effect of Mgso4 infusion.
one group name is intervention that giving to patient 1 gr Mgso4 in 100 cc normal saline for 20 min, another group name is control that 100 cc normal saline infused for 20 min as placebo. both groups patients received Loop diuretics or thiazides in last month ago.
if intervention patients show symptoms of Mgso4 toxicity (eg: patella areflexia or pulmonary depression) or with renal failure, exit this group.
Primary outcome measure are MgSo4 infusion in decreased hospitalization duration, decreased intubation, decreased dysrhythmia incidence that should be treat in ED, improvement both SaO2 and dyspnea score(verbal quantitative scale) in 6 hours after treatment initiation