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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: 01-10-2006

Copyright Statement:  Copyright © 2014; The Author(s).


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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