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

Proton pump inhibitors (PPIs) are utilized in the treatment of acid-related gastrointestinal diseases, such as gastroesophageal reflux disease (GERD) and peptic ulcers. Like any drug, they can cause side effects, some of which are observed during the clinical trial phase, while others become apparent during post-market surveillance. We present the case of a 68-year-old Caucasian female patient who had been taking a PPI (esomeprazole 40 mg twice daily) for over 10 years and presented to the Emergency Department (ED) with decreased magnesium levels (<0.5 mg/dL), hypokalemia (3.1 mmol/L), and hypocalcemia (<6.1 mg/dL), with no significant symptoms on initial presentation. The patient was treated with electrolyte repletion, and her medication was switched from omeprazole to famotidine upon stabilization of her electrolytes. She was discharged home with a follow-up appointment to further evaluate for channelopathies with Nephrology. The implications of this adverse effect underscore the importance of increased awareness among both healthcare providers and patients. Clinicians should consider the risk of PPI-induced hypomagnesemia, especially in patients with risk factors, and regularly monitor magnesium levels in individuals on long-term PPI therapy. Patients should be educated about the potential side effects of PPIs, including hypomagnesemia, and encouraged to report any concerning symptoms promptly.