Proton pump inhibitors and severe hypomagnesaemia

Area of Science:

• Gastroenterology
• Pharmacology
• Nephrology

Background:

• Proton pump inhibitors (PPIs) are widely used medications.
• Hypomagnesaemia (low magnesium levels) is a rare but serious complication associated with PPI use.
• This complication has emerged with the widespread adoption of PPI therapy.

Purpose of the Study:

• To review and summarize the current knowledge on the epidemiology, risk factors, causes, and treatment of PPI-associated hypomagnesaemia.
• To consolidate findings from peer-reviewed case reports.

Main Methods:

• Systematic review of published peer-reviewed case reports on PPI-associated hypomagnesaemia.
• Analysis of reported cases to identify patterns in epidemiology, risk factors, and clinical presentation.

Main Results:

• Hypomagnesaemia is a class effect of PPIs, observed across different substituted pyridylmethylsulphonyl benzimidazadole derivatives.
• Prolonged PPI use and high adherence are potential risk factors, though prevalence remains unknown.
• Diagnosis is frequently missed due to severe symptoms; renal magnesium handling is normal, suggesting impaired intestinal absorption as the cause.

Conclusions:

• PPI-associated hypomagnesaemia is a rare, potentially life-threatening side effect linked to extensive PPI use.
• The exact mechanism causing hypomagnesaemia is not fully understood.
• Discontinuation of PPIs leads to a rapid resolution of hypomagnesaemia.