An approach to the diagnosis and management of a case presenting with recurrent hypomagnesemia secondary to the chronic use of a proton pump inhibitor

Author(s)

dos Santos, Livia Marcela ^{[1, 2]} ; Guerra, Ricardo Ayello ^[3] ; Lazaretti-Castro, Marise ^[1] ; Vieira, Jose Gilberto H. ^[1] ; Portes, Evandro de Souza ^[3] ; Dias-da-Silva, Magnus R. ^[2]

Affiliation

^[1] Univ Fed Sao Paulo, Escola Paulista Med, Dept Med, Bone Metab Unit, Endocrinol Div, BR-04039032 Sao Paulo, SP - Brazil

^[2] Univ Fed Sao Paulo, Dept Med, Escola Paulista Med, Lab Mol & Translat Endocrinol, BR-04039032 Sao Paulo, SP - Brazil

^[3] Hosp Servidor Publ Estado Sao Paulo HSPE IAMSPE, Endocrinol Unit, Sao Paulo - Brazil

• Document type: Journal article
• Source: MAGNESIUM RESEARCH; v. 28, n. 4, p. 136-145, DEC 2015.
• Web of Science Citations: 1

Abstract

Purpose: Magnesium is an important electrolyte for very many cell functions and its deficiency may lead to a wide spectrum of diseases. We report a clinical case of hypomagnesemia resulting from the chronic use of a proton pump inhibitor (PPI). PPIs are drugs widely used in medical practice, and a growing number of cases of PPIs causing hypomagnesemia have been described. Our aim was to monitor the clinical and electrolyte findings during recovery from hypomagnesemia caused by long-term PPI use. Results: A 65-year old female who had been using omeprazole for 10 years, presented with arrhythmia and paresthesia of the lower and upper limbs that had been attributed to severe hypomagnesemia, hypocalcemia, and hypoparathyroidism. Her laboratory tests revealed the following results: magnesium 0.6 mg/dL (NR: 1.5 to 2.5 mg/dL), calcium 7.3 mg/dL (NR: 8.5 to 10.2 mg/dL), parathyroid hormone (PTH) 13.3 pg/mL (NR: 15 to 65 pg/mL), and low urinary calcium and magnesium excretion. Her electrocardiogram disclosed typical, prolonged QT interval, ST depression, and U waves. We discuss the differential diagnoses, pathophysiology, and reversibility of symptoms after effective treatment of the hypomagnesemia. Conclusion: this report emphasizes that even if long-term PPI users appear largely asymptomatic, life-threatening arrhythmias can present very suddenly. Long-term PPI users should be monitored for otherwise unexplained hypomagnesemia, hypocalcemia, functional hypoparathyroidism and associated symptoms. (AU)

• FAPESP's process: 11/20747-8 - Clinical, biochemical and molecular investigation of Thyrotoxic periodic paralysis
• Grantee: Magnus Régios Dias da Silva
• Support Opportunities: Regular Research Grants