Endocrine Abstracts

Background: Hypomagnesemia is an electrolyte disturbance defined by a low serum magnesium level. Causes of hypomagnesemia include inadequate dietary intake, decreased intestinal absorption, and increased renal excretion. The clinical presentation varies depending on the severity of the magnesium deficiency-from asymptomatic cases to patients with mild symptoms, to severe, life-threatening cardiac arrhythmias and seizures.

Case presentation: A 55-year-old man presented to the emergency department (ER) complaining of malaise, headache, paresthesias, and muscle tremors. He had been suffering from chronic diarrhea, chronic pancreatitis, arterial hypertension, type 2 diabetes mellitus diagnosed a year ago, chronic gastritis, and obesity for several years. From 2007 to 2014, four episodes of acute pancreatitis of ethyl etiology were documented. In 2021, he was admitted to ER with similar symptoms. During this observation, he developed generalized epileptic seizures and wide-QRS-complex tachycardia, both of which were due to hypomagnesemia (Mg 0.34mmol/l). On the present visit, clinical examination was unremarkable with negative Trousseau and Chvostek’s sign. ECG recording showed normal sinus rhythm with normal QRS duration. Laboratory findings showed electrolyte disturbances- hypokalemia, hypocalcemia and marked hypomagnesemia (K 3.9mmol/l, Ca 1.55mmol/l, Mg below measurable cut-off value) as well as a slight increase in inflammatory markers. Serum levels of phosphate and 25-hydroxyvitamin D were within normal range. Initial treatment-monitoring, intravenous administration of calcium gluconate and magnesium sulfate-was initiated at ER. The patient was transferred to the intensive care unit for further treatment. Five days later, he was discharged from the hospital with the recommendation of oral electrolyte replacement therapy. His electrolyte status and general condition were stable during follow-up.

Conclusions: Hypomagnesemia is more common in hospitalized patients than in the general population, and it is often associated with hypocalcemia and hypokalemia. Early recognition, diagnosis, and treatment that is easily accessible and effective are necessary to avoid complications and ensure a positive outcome.