Endocrine Abstracts

Introduction: Gastroesophageal reflux disease (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, renal disease, and other. Clinical concerns arise from a small but growing number of case reports presenting PPI-induced hypomagnesaemia as a consequence of long-term PPIs use.

Case report: We present the case of a 56-year-old patient with muscle cramps, violation of cardiac rhythm, lethargy and other caused by hypomagnesaemia (magnesium, 0.31 mmol/l), hypocalcaemia (calcium, 1.82 mmol/l), hypokalemia (kalium, 3.2 mmol/l) and hyperglycemia (6.7 mmol/l) with a low parathyroid hormone level (parathyroid hormone, 0.7 pg/ml). He had GERD and had been using a PPI (omeprazole 20-60 mg/day) since 2005. Physical examination revealed clinical signs of hypocalcaemia, hypomagnesaemia (Chvostek’s and Trousseau’s signs), hypokalemia. He had electrocardiogram abnormalities (prolonged QT interval, paroxysmal supraventricular tachycardia). After exclusion of possible causes, hypomagnesaemia secondary to PPI was diagnosed and omeprazole was stopping. Hypomagnesemia is often associated with hypokalemia (due to urinary potassium wasting) and hypocalcemia (due both to lower parathyroid hormone secretion and end-organ resistance to its effect). After only magnesium repletion all abnormalities resolved, his symptoms improved. It was shown association between hypomagnesemia and hypocalcemia, hypokalemia, hyperglycemia. A causal relation with PPI use was supported by the recurrence of hypomagnesaemia after re-challenge.

Conclusion: GERD patients using PPI should have their magnesium, kalium and calcium serum levels measured periodically, and non-specific symptoms such as asthenia, paresthesia or life-threatening manifestations (seizures, arrhythmias) should not be neglected.