Severe hypomagnesemia induced by proton pump inhibitors: description of two cases and review of the literature

Matveï Apraxine(1,2), Pierre Levecque†(3), Patrick Druez(1), Karin Dahan(4) Jean-François Cambier(2), Jean-Philippe Lengelé(2) Published in the journal : September 2019 Category : Gastroenterology

Summary :

Proton pump inhibitors, an essential treatment of gastric acid-related disorders, can cause hypomagnesemia, associated with functional hypoparathyroidism and hypocalcemia. Symptoms may be either minor like cramps or more severe like rhabdomyolysis, cardiac arrhythmias, or epilepsy. We have herein reported on two cases presenting with severe hypomagnesemia, which quickly resolved following drug withdrawal. We have additionally reviewed the underlying mechanism, which is only partially elucidated to date, though possibly linked to a reduced intestinal absorption of magnesium, which as dependent on the channel TRPM6 (transient receptor potential melastatin type 6).

What is already known about the topic?

Hypomagnesemia is a rare, often overlooked, and potentially severe complication in relation to the intake of proton pump inhibitors. This effect proves to be reversible following treatment discontinuation.

What does this article bring up for us?

Gastro-intestinal absorption of magnesium depends on an active transport through TRPM6, the activity of which appears to be modulated by the intestinal pH.

Key Words

Hypomagnesemia, proton pump inhibitors, PPI, TRPM6