Rhabdomyolysis with Multiple Electrolyte Imbalances under Proton Pump Inhibitor Treatment after Total Thyroidectomy

Area of Science:

• Endocrinology
• Nephrology
• Pharmacology

Background:

• Proton pump inhibitors (PPIs) are widely used for acid suppression.
• Long-term PPI use is associated with various adverse effects, including electrolyte disturbances.
• Patients with a history of thyroidectomy may have altered calcium metabolism.

Observation:

• A 90-year-old male presented with muscle weakness, cognitive difficulties, and dysphagia.
• He had a history of total thyroidectomy and was on lansoprazole for stress ulcer prophylaxis.
• Initial lab results revealed severe hypokalemia, hypocalcemia, hypomagnesemia, and elevated creatine kinase.

Findings:

• The patient was diagnosed with rhabdomyolysis secondary to profound electrolyte imbalances.
• These imbalances were attributed to long-term proton pump inhibitor use, exacerbated by post-thyroidectomy status.
• Discontinuation of PPIs and electrolyte repletion (intravenous hydration, oral supplements) led to normalization of magnesium, potassium, and calcium levels.

Implications:

• This case highlights the potential for PPIs to induce severe, life-threatening electrolyte derangements.
• It underscores the importance of monitoring electrolytes in patients on long-term PPI therapy, particularly those with risk factors like prior thyroidectomy.
• Clinicians should consider PPI-induced hypomagnesemia as a cause of refractory hypocalcemia and hypokalemia, especially when rhabdomyolysis is present.