Hypomagnesemia Causing Convulsions in a Patient Taking a Proton Pump Inhibitor: A Case Report

Long-term administration of proton pump inhibitors (PPIs) has been increasingly recognized to cause hypomagnesemia due to impaired magnesium absorption in both the small and large intestines. Hypomagnesemia can lead to various electrolyte imbalances, including hypokalemia, hypocalcemia, and, less commonly, hyponatremia and hypophosphatemia. Measuring serum magnesium levels is essential for identifying the underlying cause in patients receiving PPIs with unexplained electrolyte abnormalities. Currently, no standardized treatment exists for PPI-induced hypomagnesemia beyond discontinuing PPI therapy and administering magnesium supplements. The main preventive strategies in managing acid-related diseases may be a case-by-case endoscopic evaluation and early discontinuation of PPIs. This report describes a case of multiple electrolyte abnormalities, including hypomagnesemia, associated with PPI use. It highlights that serum magnesium levels may require several weeks to return to baseline following PPI discontinuation. In outpatient management, repeated serum magnesium measurements over several months are necessary rather than relying on a single assessment post-discontinuation. Furthermore, among the affected electrolytes, magnesium normalization is the most delayed, underscoring the importance of monitoring serum magnesium levels to assess treatment efficacy in cases of complex electrolyte disturbances.