Multiple dyselectrolytemia in a patient with alcohol use disorder (AUD)

Alcohol use disorder (AUD) is a chronic disease characterized by an inability to limit alcohol use despite knowledge of the negative health and social impacts. An umbrella entity, AUD encompasses the terms alcohol abuse, alcohol dependence, alcohol addiction, and alcoholism. In patients with AUD, who often have multiple electrolyte abnormalities, hypomagnesemia or magnesium deficiency can lead to prolonged hypokalemia or hypocalcemia, because magnesium is a coenzyme required for renal K excretion or 1,25-(OH)₂D₃ conversion. We experienced a 61-year-old patient with AUD with severe hypomagnesemia combined with hypokalemia and hypocalcemia. The patient had consumed alcohol habitually for about 45 years, and had an extremely irregular diet and chronic diarrheal symptoms for much of that period. When the patient was transported to our hospital for limb weakness and difficulty standing, hypokalemia (1.6 mEq/L), hypomagnesemia (1.0 mg/dL), hypocalcemia (corrected Ca 7.2 mg/dL) and elevated creatine kinase (148000 U/L) were observed. Muscle strength was remarkably reduced, with a manual muscle strength grade of 1/5 and no deep tendon reflex. Trousseau's sign and tetany symptoms were recognized, and an electrocardiogram showed prolonged QT. Following correction of the multiple electrolyte imbalances by supplementation with magnesium, potassium, calcium and vitamin D, the patient's urinary excretion of electrolytes was normalized, and improvement of the neurological findings and abnormal electrocardiogram suggested systemic improvement of electrolyte balances as well. In conclusion, when hypomagnesemia, hypokalemia and hypocalcemia are present simultaneously, a multifaceted and comprehensive approach to electrolyte imbalances may be necessary, rather than management for a single electrolyte abnormality.