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VOLUME 18 , ISSUE 7 ( July, 2014 ) > List of Articles

BRIEF COMMUNICATION

Hypomagnesemia in the intensive care unit: Choosing your gastrointestinal prophylaxis, a case report and review of the literature

Shweta Sharma, Aileen K. Wang, Paul Kim, Karen Mrejen-Shakin

Keywords : Gastroesophageal reflux, hypomagnesemia, proton pump inhibitors, seizures

Citation Information : Sharma S, Wang AK, Kim P, Mrejen-Shakin K. Hypomagnesemia in the intensive care unit: Choosing your gastrointestinal prophylaxis, a case report and review of the literature. Indian J Crit Care Med 2014; 18 (7):456-460.

DOI: 10.4103/0972-5229.136075

License: CC BY-ND 3.0

Published Online: 01-07-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

We report a case of symptomatic hypomagnesaemia in medical intensive care unit that is strongly related to proton pump inhibitors (PPIs) and provide literature review. A 65-year-old male with severe gastroesophageal reflux on omeprazole 20 mg orally twice a day, who presented to the hospital with abdominal pain, nausea, diarrhea, and new onset seizures. On admission, his serum magnesium level was undetectable. Electrocardiogram showed a new right bundle branch block with a prolonged QT interval. The hypomagnesemia was corrected with aggressive magnesium supplementation and hypomagnesemia resolved only after the PPI was stopped. Neurologic and cardiac abnormalities were corrected. This is a life-threatening case of an undetectable magnesium level strongly associated with PPI use. In critically, ill patients with refractory hypomagnesemia, we advocate considering changing gastrointestinal prophylaxis from a PPI to a histamine-receptor blocker.


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  1. Fda.gov. FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of proton-pump inhibitor drugs (PPIs). Drug Safety Communication. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm245011.htm.  [2011 Mar 02].
  2. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6.
  3. Globalrph.com. Globalrph: The clinician ultimate reference. Available from: http://www.globlarph.com/conversional_si.htm. [Last accessed 2011 Oct 14].
  4. Furlanetto TW, Faulhaber GA. Hypomagnesemia and proton pump inhibitors: Below the tip of the iceberg. Arch Intern Med 2011;171:1391-2.
  5. Hoorn EJ, van der Hoek J, de Man RA, Kuipers EJ, Bolwerk C, Zietse R. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6.
  6. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.
  7. Bringhurst FR, Demay MB, Krane SM, Kronenberg HM. Bone and mineral metabolism in health and disease. In: Kasper DL, Braunwald E, Faui AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison′s Principles of Internal Medicine. 16 th ed. United States of America: McGraw-Hill Publishers; 2005. p. 2238-49.
  8. Buckley MS, Leblanc JM, Cawley MJ. Electrolyte disturbances associated with commonly prescribed medications in the intensive care unit. Crit Care Med 2010;38 6 Suppl: S253-64.
  9. Pham PC, Pham PM, Pham SV, Miller JM, Pham PT. Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol 2007;2:366-73.
  10. Regolisti G, Cabassi A, Parenti E, Maggiore U, Fiaccadori E. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74.
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5.
  12. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors: A review. Neth J Med 2009;67:169-72.
  13. Schmitz C, Perraud AL, Fleig A, Scharenberg AM. Dual-function ion channel/protein kinases: Novel components of vertebrate magnesium regulatory mechanisms. Pediatr Res 2004;55:734-7.
  14. Chubanov V, Schlingmann KP, Wäring J, Heinzinger J, Kaske S, Waldegger S, et al. Hypomagnesemia with secondary hypocalcemia due to a missense mutation in the putative pore-forming region of TRPM6. J Biol Chem 2007;282:7656-67.
  15. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41.
  16. Li M, Du J, Jiang J, Ratzan W, Su LT, Runnels LW, et al. Molecular determinants of Mg2+ and Ca2+ permeability and pH sensitivity in TRPM6 and TRPM7. J Biol Chem 2007;282:25817-30.
  17. Thongon N, Krishnamra N. Omeprazole decreases magnesium transport across Caco-2 monolayers. World J Gastroenterol 2011;17:1574-83.
  18. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: A clinical case series. QJM 2010;103:387-95.
  19. Metz DC, Sostek MB, Ruszniewski P, Forsmark CE, Monyak J, Pisegna JR. Effects of esomeprazole on acid output in patients with Zollinger-Ellison syndrome or idiopathic gastric acid hypersecretion. Am J Gastroenterol 2007;102:2648-54.
  20. Shabajee N, Lamb EJ, Sturgess I, Sumathipala RW. Omeprazole and refractory hypomagnesaemia. BMJ 2008;337:a425.
  21. François M, Lévy-Bohbot N, Caron J, Durlach V. Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism? Ann Endocrinol (Paris) 2008;69:446-8.
  22. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6.
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