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07 June 2022 : Case report  Canada

[In Press] Severe Electrolyte Disturbances Due to Proton Pump Inhibitor Therapy: An Underrecognized Problem with Potentially Severe Sequelae

Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy

Senyo Tagboto12ABCDEF

DOI: 10.12659/AJCR.936893

Am J Case Rep In Press; DOI: 10.12659/AJCR.936893  

Available online: 2022-06-07, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Proton pump inhibitors are increasingly being recognized as a cause of multiple electrolyte disturbances, including hypomagnesemia, hypocalcemia, hypophosphatasemia, hypokalemia and hyponatremia, particularly in persons on long-term therapy. The mechanisms, consequences, and management of these electrolyte disturbances are discussed below.
A 55-year-old woman was seen by various clinicians, with a variety of clinical presentations, over the space of a couple of years. During each visit, she had electrolyte disturbances and was on proton pump inhibitor therapy, which were either continued or changed to a different proton pump inhibitor. She had presented variously with diarrhea and weight loss due to microscopic colitis, confusion, and grand mal seizures on separate occasions. Changing the proton pump inhibitor did not alleviate her profound electrolyte disturbances, which completely resolved shortly after stopping drug therapy.
It is important for clinicians to be aware of the electrolyte disturbances that can be caused by these medications, and to actively monitor patients on long-term therapy for these disturbances, thus avoiding potentially severe consequences. Electrolyte disturbances are more likely to arise in patients who are prescribed concomitant diuretic treatment or who overuse alcohol. The incidental finding of hypocalcemia in persons on proton pump inhibitors may be secondary to hypomagnesemia, and hypomagnesemia may be a consequence of an underlying otherwise symptomless genetic disorders. Clinicians should be encouraged to deprescribe these drugs after 4 weeks of treatment in patients with mild symptoms or mild disease.

Keywords: Colitis, Microscopic; Confusion; Electrolytes; Hypomagnesemia 1, Intestinal; Proton Pump Inhibitors; Seizures


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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923