Syncope and the Inability to Move: Was It the Magnesium?

Proton pump inhibitors (PPIs) were clinically introduced more than 30 years ago and have been a very safe and effective agent for the treatment of a variety of different acid-base disorders. PPIs work by inhibiting the final step in gastric acid synthesis production by covalently binding to the (H+,K+)-ATPase enzyme system at the level of the gastric parietal cells leading to the irreversible inhibition of gastric acid secretion until new enzymes are produced. This inhibition is useful in a wide variety of disorders, which include, but are not limited to, gastroesophageal reflux disease (GERD), peptic ulcer disease, erosive esophagitis, Helicobacter pylori infection, and pathological hypersecretory disorders. Despite PPIs' overall excellent safety profile, PPIs have raised concerns about both short- and long-term complications including multiple electrolyte derangements that can lead to life-threatening situations. We present a case of a 68-year-old male who presented to the emergency department after a syncopal episode with profound weakness and was found to have undetectable magnesium levels secondary to long-term omeprazole use. This case report highlights how important it is for clinicians to be aware of these electrolyte disturbances and the importance of monitoring electrolytes while being on these medications.