Prolonged Proton Pump Inhibitor Use and Electrolyte Abnormalities: A Case Presentation and Literature Review.

Area of Science:

• Gastroenterology
• Clinical Pharmacology
• Nephrology

Background:

• Proton pump inhibitors (PPIs) are widely prescribed for acid-related gastrointestinal disorders like GERD and peptic ulcers.
• While generally safe, PPIs can cause adverse effects, some identified during clinical trials and others post-market.
• Long-term PPI use is associated with potential complications requiring vigilant monitoring.

Observation:

• A case report details a 68-year-old female on long-term esomeprazole (a PPI) presenting with severe hypomagnesemia, hypokalemia, and hypocalcemia.
• The patient exhibited no significant symptoms on initial presentation despite critical electrolyte derangements.
• Electrolyte levels were <0.5 mg/dL for magnesium, 3.1 mmol/L for potassium, and <6.1 mg/dL for calcium.

Findings:

• The patient's electrolyte abnormalities resolved after repletion and switching from esomeprazole to famotidine.
• This case highlights a potential link between prolonged PPI therapy and severe electrolyte depletion.
• Further evaluation for channelopathies was recommended upon discharge.

Implications:

• Clinicians must maintain a high index of suspicion for PPI-induced hypomagnesemia, especially in patients on long-term therapy or with risk factors.
• Regular monitoring of magnesium levels is crucial for individuals on chronic PPI treatment.
• Patient education regarding potential PPI side effects, including electrolyte disturbances, is essential for prompt reporting and management.