title: Proton pump inhibitor associated hypomagnasaemia - a cause for concern?
abstract: OBJECTIVE
  In recent years, there have been a number of case reports of severe hypomagnesaemia associated with proton pump inhibitor (PPI) use, such that both the FDA and MHRA have issued drug safety warnings. They have recommended periodic serum magnesium testing in patients prescribed PPIs but provide no guidance on timing of these measurements.
  
  
  METHODS
  To our knowledge, we are the first to perform a prospective study to explore specifically proton pump inhibitor associated hypomagnesaemia (PPIAH). We followed 56 patients new to PPIs prospectively as well as a further 100 patients on long term PPIs cross-sectionally to identify what factors may be influencing the development of significant hypomagnesaemia.
  
  
  RESULTS
  For the prospective arm of the study, we measured serum magnesium levels prior to starting a PPI and again at regular intervals for the next 8 months. For the cross-sectional arm of the study we measured serum magnesium levels on patients on PPI therapy ranging from less than 1 year to over 5 years.
  
  
  CONCLUSIONS
  We found that, although there was a significant downward trend in serum magnesium levels in patients new to PPI therapy with time, clinically relevant hypomagnesaemia was not readily identifiable on regular blood testing. We did however identify patients on concurrent diuretic therapy as being at higher risk and so would recommend regular serum magnesium testing alongside their regular renal function monitoring on a more frequent basis such as annually.
authors.affiliation: Department of Clinical Biochemistry, Royal Bournemouth Hospital, Bournemouth.
authors.forename: Joe
authors.initials: J
authors.lastname: Begley
authors.affiliation: Department of Gastroenterology, Southampton Universities Hospital, Southampton.
authors.forename: Trevor
authors.initials: T
authors.lastname: Smith
authors.affiliation: Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Barnett
authors.affiliation: Department of Statistics, Salisbury Hospital, Salisbury.
authors.forename: Paul
authors.initials: P
authors.lastname: Strike
authors.affiliation: Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth.
authors.forename: Adnan
authors.initials: A
authors.lastname: Azim
authors.affiliation: Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth.
authors.forename: Claire
authors.initials: C
authors.lastname: Spake
authors.affiliation: Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth.|Centre of Postgraduate Medical Research and Education, Bournemouth University, Bournemouth, UK.
authors.forename: Tristan
authors.initials: T
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008274:Magnesium / Q000097:blood* / Q000652:urine; D008275:Magnesium Deficiency / Q000097:blood / Q000139:chemically induced* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D008274:Magnesium
keywords: hypomagnesaemia; magnesium; proton pump inhibitors