An electrolyte disturbance masquerading as a panic attack
Anne Wildermuth1, Meagan Lantz, Erin Sagers
1Anne Wildermuth is an assistant professor in the School of Medicine at the Uniformed Services University in Bethesda, Md., and practices in emergency medicine with MedStar Emergency Physicians in Clinton, Md. At the time this article was written, Meagan Lantz and Erin Sagers were students in the PA program at the George Washington University in Washington, D.C. Ms. Lantz now practices in cardiothoracic surgery at Stanford Health Care in Palo Alto, Calif. Ms. Sagers now practices in orthopedics at EmergeOrtho Coastal Region in Wilmington, N.C. The authors have disclosed no potential conflicts of interest, financial or otherwise. The views expressed in this article are those of the authors and not of the Department of Defense, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., or other federal agencies.
Proton pump inhibitors (PPIs) can cause low magnesium, leading to hypocalcemia and symptoms like muscle cramps. Regular electrolyte monitoring is crucial when using these common medications.
Area of Science:
- Internal Medicine
- Clinical Pharmacology
Background:
- Proton pump inhibitors (PPIs) are widely prescribed medications.
- Potential adverse effects of PPIs are often overlooked due to their common usage.
Purpose of the Study:
- To highlight a case of hypocalcemia secondary to PPI-induced hypomagnesemia.
- To emphasize the importance of monitoring electrolytes during PPI therapy.
Main Methods:
- Case report detailing a patient presenting with paresthesias and muscle cramps.
- Analysis of the patient's condition, linking symptoms to hypocalcemia and hypomagnesemia.
- Review of literature regarding PPI-induced electrolyte disturbances.
Main Results:
- The patient's symptoms of paresthesias and muscle cramps were misdiagnosed as panic attacks.
- The underlying cause was identified as hypocalcemia resulting from PPI-induced hypomagnesemia.
- This case underscores a potential, yet often unconsidered, adverse reaction to PPIs.
Conclusions:
- Proton pump inhibitors require cautious and appropriate use.
- Regular monitoring of electrolytes, particularly magnesium, is recommended during PPI therapy.
- Consideration for vitamin B12 levels is also advised in patients on long-term PPIs.
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