Late-onset Complications in a Chronic Proton Pump Inhibitor User: Electrolyte Abnormalities and a Diagnostic Approach

Area of Science:

• Endocrinology
• Gastroenterology
• Internal Medicine

Background:

• Proton pump inhibitors (PPIs) are widely used for acid-related gastrointestinal disorders.
• Long-term PPI therapy is generally considered safe, but potential adverse effects require ongoing monitoring.
• Electrolyte disturbances, particularly hypomagnesemia, have been associated with PPI use.

Observation:

• A patient with a 15-year history of PPI use presented with acute, severe hypocalcemia, hypomagnesemia, and hypokalemia.
• Symptoms included perioral tingling, fingertip paresthesia, and acute confusion.
• The electrolyte abnormalities recurred, prompting PPI discontinuation.

Findings:

• Extensive workup excluded other causes of hypocalcemia, hypomagnesemia, and hypokalemia.
• The patient's electrolyte derangements were attributed to PPI-induced hypomagnesemia.
• This occurred despite many years of prior asymptomatic PPI use.

Implications:

• Refractory hypocalcemia and hypokalemia should prompt evaluation for concurrent hypomagnesemia.
• Physicians should consider PPI-induced hypomagnesemia as a potential cause of severe electrolyte disturbances, even in patients with a long history of use.
• Early recognition and management of PPI-induced hypomagnesemia can prevent severe complications and reduce hospitalizations.