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Clinical Observation |

Hypomagnesemia and Proton Pump Inhibitors:  Below the Tip of the Iceberg

Tania Weber Furlanetto, MD, PhD; Gustavo Adolpho Moreira Faulhaber, MD, PhD
Arch Intern Med. 2011;171(15):1391-1392. doi:10.1001/archinternmed.2011.199.
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Severe magnesium deficiency associated with proton pump inhibitors (PPIs) has been described recently with clinical presentations varying from life-threatening conditions to muscle cramps and paresthesias. Probably milder cases go undetected. We report an asymptomatic case of hypomagnesemia associated with chronic use of PPIs in a 67-year-old woman. She had had symptoms of gastroesophageal reflux disease for several years, which abated partially with PPIs, and denied any other symptoms or medications. Her initial evaluation showed an unexplained hypomagnesemia with a very low magnesium excretion rate in urine. Serum calcium, phosphorus, potassium, and glucose levels and renal function were normal. After PPI withdrawal, serum and urinary magnesium levels normalized.

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Figure. Serum and urinary magnesium levels and proton pump inhibitor (PPI) use. GERD indicates gastroesophageal reflux disease. *A dosage of about 1000 mg. †A dosage of 40 mg tapered to 15 mg. To convert serum magnesium levels from milligrams per deciliter to millimoles per liter and urine magnesium from milligrams per 24 hours to millimoles per day, multiply by 0.411.

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