Severe Hypomagnesemia with Long-Term Use of a Proton Pump Inhibitor: A Case Report

2015 ◽  
Vol 10 (3) ◽  
Author(s):  
Amy M Trottier MSc MD ◽  
Paul S Gibson MD FRCPC
Keyword(s):  
Proton Pump ◽  
Hormone Level ◽  
Serum Magnesium ◽  
Electrolyte Disorders ◽  
Annual Basis ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Baseline Testing ◽  
Electrolyte Abnormalities

Hypomagnesemia is a rare, though likely under-recognized, adverse effect of long-term use of proton pump inhibitors (PPIs), one of the most commonly prescribed classes of medications in North America. Hypomagnesemia can cause potentially life-threatening neurologic abnormalities, cardiac arrhythmias, and secondary electrolyte disorders. In this manuscript we present the case of a long-term PPI user who presented with an episode of decreased level of consciousness. He was found to have severe hypomagnesemia with avid renal retention of magnesium, secondary hypocalcemia with an inappropriately normal parathyroid hormone level, and hypokalemia. His serum magnesium and other electrolyte abnormalities rapidly corrected with cessation of PPI use and electrolyte supplementation. Given the propensity for patients with hypomagnesemia associated with PPI use to go unrecognized until they present with severe symptomatic hypomagnesemia, we recommend that patients being started on a PPI for an intended long-term course have baseline testing of serum magnesium and monitoring of magnesium on an annual basis, or sooner, if they develop symptoms.

scholarly journals Iatrogenic hypomagnesemia: an underestimated clinical problem

2015 ◽  
Vol 9 (3) ◽  
pp. 287 ◽  
Author(s):  
Antonio Villa ◽  
Paolo Zanada ◽  
Adriana Pellegrino ◽  
Gabriella Nucera ◽  
Elena Martinoli ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Serum Magnesium ◽  
Concomitant Administration ◽  
Clinical Problem ◽  
Proton Pump Inhibitor Therapy ◽  
Term Therapy ◽  
Long Term Therapy ◽  
The Relationship

Hypomagnesemia is defined by having a serum magnesium level of less than 1.7 mg/dL. The magnesium balance is tightly regulated by the concerted actions of the intestine, bone and kidneys. This balance can be disturbed by a wide variety of drugs. Recently, we observed a case of severe hypomagnesemia caused by proton pump inhibitor therapy. We conducted a retrospective study of an <em>intrahospital population</em> to evaluate the prevalence of hypomagnesemia and the relationship with associated drugs. Among 181 patients with hypomagnesemia only 29 were found to have hypomagnesemia with specific causes, such as chronic diarrhea, vomiting, and so on. In the remaining patients, 120 have taken proton pump inhibitors and/or diuretics and/or metformin. Clinicians should consider proton pump inhibitors as a possible causative agent when investigating hypomagnesemia and they should be especially attentive with patients who take proton pump inhibitors, especially in cases of long-term therapy (≥1 year) and/or concomitant administration of other agents that may lower magnesium levels (<em>e.g</em>., diuretics or metformin).

scholarly journals Cardioprotective Therapy in the Practice of an Anaesthesiologist

2020 ◽  
Author(s):  
Arina Viacheslavovna Balan
Keyword(s):  
Neurological Status ◽  
Underlying Disease ◽  
Research Papers ◽  
Vital Functions ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Published Research ◽  
The Brain ◽  
Careful Assessment

All components of anaesthesia have a direct or indirect depressing effect on the myocardium and functional activity of the brain. Given the initial failure of the coronary blood flow, life-threatening disorders of the heart are possible. The higher the severity of the underlying disease, the greater the risk of transient neurological deficit, stroke. Extended continuous monitoring of vital functions, careful assessment of the neurological status of the patient with special attention to the level of consciousness, the presence or absence of symptoms of increased ICP is necessary. The purpose of this study is to evaluate the beneficial effect of cardioprotectors Mexicor, Meldonium in the fight against ischemia in patients with CHD, GB in the department of surgical profile. The following methods have been used: review of literature, previously published research papers. Results: this article discusses the main drugs with cardioprotective properties, describes the positive experience of using them by specialists, and proves the effectiveness of using drugs in the long term.

scholarly journals Functional hypoparathyroidism secondary to magnesium deficiency in long-term users of proton pump inhibitor

2018 ◽  
Vol 20 (3) ◽  
pp. 102-107
Author(s):  
Lilit V. Egshatyan
Keyword(s):  
Renal Disease ◽  
Proton Pump ◽  
Bone Fractures ◽  
Magnesium Deficiency ◽  
Chronic Renal Disease ◽  
Causal Relation ◽  
Case Reports ◽  
Serum Magnesium ◽  
Lifestyle Changes

Gastroesophageal reflux disease (GERD) is a gastrointestinal motility disorder that results from the reflux of stomach contents into the esophagus resulting in symptoms or complications. GERD is now widely prevalent around the world, with clear evidence of increasing prevalence in many developing countries. Treatment for most people with GERD includes lifestyle changes and medication. Proton pump inhibitors (PPIs) are a mainstay therapy for all gastric acid-related diseases. Long-term use of PPIs is associated with hypomagnesaemia, hypokalemia, hypocalcaemia, osteoporosis and bone fractures, chronic renal disease, acute renal disease, and other. Clinical concerns arise from a small but growing number of case reports presenting PPI-induced hypomagnesaemia. In 2011 the U.S. Food and Drug Administration is informing the public that prescription PPI may cause low serum magnesium levels if taken for prolonged periods of time. In this article, we present the case of a 56-year-old patient with muscle cramps, violation of cardiac rhythm, lethargy and other caused by hypomagnesaemia, hypocalcaemia and hypokalemia with a low parathyroid hormone level while using a PPI. After magnesium repletion abnormalities resolved. A causal relation with PPI use was supported by the recurrence of hypomagnesaemia after re-challenge.

Neurological Effects of Proton Pump Inhibitors- A Review

2017 ◽  
Vol 8 (03) ◽  
Author(s):  
Patil T. R. ◽  
Patil S. T. ◽  
Patil S. ◽  
Patil A.
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Over The Counter ◽  
Inappropriate Use ◽  
Beta Secretase ◽  
Life Threatening ◽  
Amyloid Aβ ◽  
Neurological Effects ◽  
Vacuolar Atpases

Proton pump inhibitors [PPIs] are extensively used drugs for various indications. They are not approved for long term use by regulatory authorities. PPIs are also available as over the counter drugs which can lead to their inappropriate use. Amongst the adverse drug reactions [ADRs] of PPIs, dementia and Alzheimers disease [AD] are the recent ones. Inappropriate long term use of PPIs can lead to serious ADRs like myocardial infarction, nephropathy along with dementia. The possible mechanisms for PPIs induced dementia and AD are endothelial dysfunction, its aging and senescence. Effect on lysosomal function and proteostasis, shortening of telomere length, and inhibition of vacuolar ATPases [V-ATPases] of microglial lysosomal membrane also contribute for this pathology. Increased generation of beta amyloid [Aβ] peptide by inverse gama secretase modulation and augmentation of beta secretase are responsible for the generation and accumulation of Aβ along with its decreased degradation as a result of inhibition of V-ATPases in the microglia. Vitamin B 12 absorption is decreased due to long term use of PPIs. This also contributes for nerve damage as a result of impaired DNA synthesis, methylation and homocysteine neurotoxicity along with cognition impairment. Seizure like condition can be the result of hypomagnesemia induced by long term PPIs use. Thus long term, inappropriate use of PPIs invite serious and life threatening conditions which need to be kept in mind by the clinician before prescribing them.

A Cross Sectional Clinical Study to Assess the Influence of Chronic Proton Pump Inhibitor Therapy on Serum Magnesium Levels

2020 ◽  
Vol 23 (15) ◽  
Author(s):  
S. Saradha ◽  
R. Arunkumar ◽  
M. Chokkalingam ◽  
A. Ruckmani ◽  
S. Babukumar ◽  
...  
Keyword(s):  
Clinical Study ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Serum Magnesium ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy ◽  
Cross Sectional

Proton Pump Inhibitors in 2021: Pros, Cons, and Everything in Between

2021 ◽  
pp. 263451612110217
Author(s):  
Joshua A. Sloan ◽  
Philip O. Katz
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adverse Events ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Drug Class ◽  
Life Threatening

The medical and lay literature has exploded with reports of adverse events associated with proton pump inhibitors over the last 10 to 15 years. The dissemination of these reports to patients and clinicians have created substantial concerns regarding what has been an exceptionally valuable drug class, dramatically improving patient quality of life, and in many cases preventing life threatening side effects of other medication. Patients are more frequently seeking to avoid these medications, and practitioners are reducing or discontinuing them to the patient’s detriment due to a misunderstanding of the data. This review will discuss the data regarding the most commonly publicized adverse events and attempt to put them in perspective.

scholarly journals Long-term outcomes after penile prosthesis placement for the Management of Erectile Dysfunction: a single-Centre experience

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Valentine Frydman ◽  
Ugo Pinar ◽  
Maher Abdessater ◽  
William Akakpo ◽  
Pietro Grande ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Erectile Dysfunction ◽  
Penile Prosthesis ◽  
Perioperative Outcomes ◽  
Single Centre ◽  
Satisfactory Outcome ◽  
Single Centre Experience ◽  
Life Threatening ◽  
Few Data

Abstract Background Penile prothesis (PP) is the gold-standard treatment of drug-refractory erectile dysfunction (ED). While postoperative outcomes have been widely described in the literature, there are few data about patient satisfaction and intraoperative events. We aimed to assess long-term patient satisfaction and perioperative outcomes after PP implantation in a single-centre cohort of unselected patients using validated scales. Results A total of 130 patients received a PP (median age: 62.5 years [IQR: 58–69]; median International Index of Erectile Function (IEEF-5) score: 6 [IQR: 5–7]). Median follow-up was 6.3 years [IQR: 4–9.4]. Thirty-two (24.6%) patients underwent surgical revision, of which 20 were PP removals (15.4%). Global PP survival rate was 84.6% and previous PP placement was a risk factor for PP removal (p = 0.02). There were six (4.6%) non-life-threatening intraoperative events including two which resulted in non-placement of a PP (1.5%). EAUiaic grade was 0 for 124 procedures (95.4%), 1 for four procedures (3.1%) and 2 for two procedures (1.5%). Of patients who still had their PP at the end of the study, 91 (80.5%) expressed satisfaction. Conclusions PP implantation is a last-resort treatment for ED with a satisfactory outcome. PPs are well accepted by patients.

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