Thinking Outside the Box: A Case of Persistent Symptomatic Hypomagnesemia.

Area of Science:

• Internal Medicine
• Clinical Pharmacology
• Nephrology

Background:

• Hypomagnesemia is an underdiagnosed condition with significant health implications.
• Drug-induced causes, particularly iatrogenesis, are frequently overlooked in etiological investigations.
• Proton pump inhibitors (PPIs) are widely used medications with potential adverse effects.

Observation:

• A 78-year-old female presented with recurrent, severe hypomagnesemia of unknown etiology.
• Extensive investigations were conducted to identify the underlying cause of the persistent low magnesium levels.
• The patient was found to be on monotherapy with PPIs.

Findings:

• Proton pump inhibitors (PPIs) were identified as the causative agent for severe hypomagnesemia.
• This adverse effect of PPIs can occur even when used as monotherapy.
• The precise mechanisms underlying PPI-induced hypomagnesemia are not yet fully elucidated.

Implications:

• Increased clinical awareness of PPI-induced hypomagnesemia is crucial for timely diagnosis and management.
• Systematic review of medications, including PPIs, should be considered in patients with unexplained hypomagnesemia.
• Routine magnesium monitoring in patients on long-term PPI therapy may be beneficial to prevent severe electrolyte disturbances.