Delay in diagnosis of proton pump inhibitor induced hypomagnesaemia: A case series

Abstract

Proton pump inhibitor (PPI) induced hypomagnesaemia is an increasingly recognised side effect of these commonly used medications. We present a case series highlighting the delay in diagnosis of PPI induced hypomagnesaemia, in three patients who presented with symptomatic electrolyte abnormalities. Our first case depicts that, despite multiple presentations to an emergency department in a tertiary hospital, PPIs were not recognised as the underlying cause of hypomagnesaemia and hypocalcaemia. Our second case highlights the difficulty faced by primary case physicians in recognising this side effect. Similarly, our third case demonstrates these challenges in a patient that presented to hospital twice, before the offending agent was ceased. Given the widespread use of PPIs and the simplicity in treating this side effect, we aim to shed light on the incidence of PPI induced hypomagnesaemia. We suggest that a high index of suspicion must be maintained for patients on PPIs, who can present with potentially life threatening electrolyte derangement. Keywords: Proton pump inhibitor, Hypomagnesaemia, Hypocalcaemia, Hypoparathyroidism, PPI, Side effect