title: Hypomagnesemia in the intensive care unit: Choosing your gastrointestinal prophylaxis, a case report and review of the literature.
abstract: We report a case of symptomatic hypomagnesaemia in medical intensive care unit that is strongly related to proton pump inhibitors (PPIs) and provide literature review. A 65-year-old male with severe gastroesophageal reflux on omeprazole 20 mg orally twice a day, who presented to the hospital with abdominal pain, nausea, diarrhea, and new onset seizures. On admission, his serum magnesium level was undetectable. Electrocardiogram showed a new right bundle branch block with a prolonged QT interval. The hypomagnesemia was corrected with aggressive magnesium supplementation and hypomagnesemia resolved only after the PPI was stopped. Neurologic and cardiac abnormalities were corrected. This is a life-threatening case of an undetectable magnesium level strongly associated with PPI use. In critically, ill patients with refractory hypomagnesemia, we advocate considering changing gastrointestinal prophylaxis from a PPI to a histamine-receptor blocker.
authors.affiliation: Department of Medicine, Queens Hospital Center, Mount Sinai School of Medicine, Jamaica, NY, USA.
authors.forename: Aileen K
authors.initials: AK
authors.lastname: Wang
authors.affiliation: Department of Medicine, Queens Hospital Center, Mount Sinai School of Medicine, Jamaica, NY, USA.
authors.forename: Shweta
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Queens Hospital Center, Mount Sinai School of Medicine, Jamaica, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kim
authors.affiliation: Department of Medicine, Queens Hospital Center, Mount Sinai School of Medicine, Jamaica, NY, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Mrejen-Shakin
keywords: Gastroesophageal reflux; hypomagnesemia; proton pump inhibitors; seizures
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