Title : Magnesium sulfate as an alternative treatment in acute organophosphate poisoning: A systematic review and meta-analysis

Abstract:

Introduction: Organophosphate (OP) poisonings represent a serious medical emergency requiring immediate intervention. The conventional treatment involves administration of atropine. However, studies suggest that magnesium sulfate (MgSO4) could be a promising alternative treatment. Therefore, this meta-analysis aims to compare the use of MgSO4 in the treatment of OP poisonings with conventional treatment.

Methods: This analysis was conducted following PRISMA guidelines. In May 2024, we searched multiple databases (Pubmed, Embase and Cochrane) for randomized controlled trials (RCTs) evaluating the use of MgSO4 in OP poisoned patients. Our primary outcome was mortality. Statistical analysis was performed using Review Manager software, employing Mantel-Haenszel test was performed using a random effects model Relative Risk (RR) was calculated for binary outcomes. Subgroup analysis was conducted for studies with low heterogeneity using fixed-effects models. Risk assessment was performed using the Risk of Bias 2 tool.

Results: Our search identified 4 eligible RCTs meeting inclusion criteria, involving 275 patients, of whom 131 (47,63%) received MgSO? with complementary atropine and the remaining 144 received placebo. Statistical data indicated that OP poisoned patients treated with MgSO? showed lower mortality compared to the control group (RR 0.35, 95% CI 0.17-0.70; p < 0.04; I² 0%).

Conclusions: These findings suggest that the use of MgSO4 may significantly contribute to OP poisoning therapy, offering a strategy to mitigate cholinergic hyperstimulation effects and reduce mortality.