Abstract:Hypomagnesemia is usually defined as a serum magnesium (Mg) level below 0.65 mmol/L (1.3 mEq/L; 1.5 mg/dl). 1 Serum Mg exists in three forms: (1) free or ionized Mg, the physiologically active form that accounts for 55%-70% of total serum Mg; (2) Mg complexed to anions, including bicarbonates, sulfates, phosphates, and citrates (5%-15%) and (3) Mg bound to serum proteins (primarily albumin), constituting the remaining approximately 30%. 2 Similarly to hypocalcemia, hypoalbuminemia is also related to spurious h… Show more
“…Excessive alcohol intake can be associated with hypomagnesemia. This could be due to multiple mechanisms, including decreased magnesium intake, increased gastrointestinal Mg losses in patients with chronic diarrhea, increased Mg entry into cells due to both respiratory alkalosis and excessive catecholamine release in alcohol withdrawal syndrome, inappropriate urinary losses due to alcohol-induced tubular damage, alcohol-related metabolic acidosis, and acute pancreatitis [ 17 , 18 ].…”
Section: Discussionmentioning
confidence: 99%
“…Hypomagnesemia has been reported to cause carpopedal spasm, tetany, convulsions, cardiac arrhythmias, hypoparathyroidism, hypocalcemia, hypophosphatasemia, muscle cramps or weakness, vertigo, ataxia, seizures, depression, and psychosis [ 16 , 18 ]. Hypomagnesemia typically recurs following replacement of one proton pump inhibitor with another [ 19 ].…”
Patient: Female, 55-year-old
Final Diagnosis: Convulsions and confusion due to electrolyte disturbances
Symptoms: Confusion • convulsions
Medication: —
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology
Objective:
Unusual clinical course
Background:
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.
Case Report:
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.
Conclusions:
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.
“…Excessive alcohol intake can be associated with hypomagnesemia. This could be due to multiple mechanisms, including decreased magnesium intake, increased gastrointestinal Mg losses in patients with chronic diarrhea, increased Mg entry into cells due to both respiratory alkalosis and excessive catecholamine release in alcohol withdrawal syndrome, inappropriate urinary losses due to alcohol-induced tubular damage, alcohol-related metabolic acidosis, and acute pancreatitis [ 17 , 18 ].…”
Section: Discussionmentioning
confidence: 99%
“…Hypomagnesemia has been reported to cause carpopedal spasm, tetany, convulsions, cardiac arrhythmias, hypoparathyroidism, hypocalcemia, hypophosphatasemia, muscle cramps or weakness, vertigo, ataxia, seizures, depression, and psychosis [ 16 , 18 ]. Hypomagnesemia typically recurs following replacement of one proton pump inhibitor with another [ 19 ].…”
Patient: Female, 55-year-old
Final Diagnosis: Convulsions and confusion due to electrolyte disturbances
Symptoms: Confusion • convulsions
Medication: —
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology
Objective:
Unusual clinical course
Background:
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.
Case Report:
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.
Conclusions:
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.
“…Some antineoplastic agents (i.e., cisplatin) and birth control pills cause an increased renal excretion of magnesium. Finally, calcineurin inhibitors and iron-based phosphate intestinal binders are also associated with hypomagnesaemia [ 39 ].…”
Section: Interaction Between Drugs and Nutritional Statusmentioning
confidence: 99%
“…A condition of hypocalcemia may be the result of four different conditions [ 39 , 41 ]: hypoparathyroidism, hypovitaminosis D, calcium binding agents, or impaired bone resorption. Medications most often associated with hypocalcemia are loop diuretics (for increased calcium excretion), chelating agents (i.e., ethylenediaminetetracetate, citrate, phosphate), antineoplastic drugs (i.e., cisplatin, leucovorin, 5-fluorouracil, nab-paclitaxel, axitinib), biphosphates, calcitonin and denosumab (a monoclonal antibody used to treat osteoporosis).…”
Section: Interaction Between Drugs and Nutritional Statusmentioning
Drugs and food interact mutually: drugs may affect the nutritional status of the body, acting on senses, appetite, resting energy expenditure, and food intake; conversely, food or one of its components may affect bioavailability and half-life, circulating plasma concentrations of drugs resulting in an increased risk of toxicity and its adverse effects, or therapeutic failure. Therefore, the knowledge of these possible interactions is fundamental for the implementation of a nutritional treatment in the presence of a pharmacological therapy. This is the case of chronic kidney disease (CKD), for which the medication burden could be a problem, and nutritional therapy plays an important role in the patient’s treatment. The aim of this paper was to review the interactions that take place between drugs and foods that can potentially be used in renal patients, and the changes in nutritional status induced by drugs. A proper definition of the amount of food/nutrient intake, an adequate definition of the timing of meal consumption, and a proper adjustment of the drug dosing schedule may avoid these interactions, safeguarding the quality of life of the patients and guaranteeing the effectiveness of drug therapy. Hence, a close collaboration between the nephrologist, the renal dietitian, and the patient is crucial. Dietitians should consider that food may interact with drugs and that drugs may affect nutritional status, in order to provide the patient with proper dietary suggestions, and to allow the maximum effectiveness and safety of drug therapy, while preserving/correcting the nutritional status.
“…El nivel normal es de 1,5 a 3,0mEq/L; en el organismo se encuentra en tres estados: Mg ionizado o libre 55-70% es la forma activa; ligado a proteínas (albúmina) 30% y formando complejos aniónicos (bicarbonato, sulfatos, fosfatos y citratos) 5-15% (24,25); debido a que la mayor parte del Mg es intracelular, el nivel sérico no siempre refleja la concentración corporal total (22).…”
Los líquidos y los electrolitos son constituyentes indispensables de cuyo equilibrio depende el normal funcionamiento del organismo, sus alteraciones tanto en exceso como en déficit repercuten negativamente en el estado de salud, su reconocimiento temprano, su oportuna corrección y la reevaluación frecuente son puntos clave para el retorno a la salud. En el siguiente capítulo se revisará las principales alteraciones de los líquidos y electrolitos.
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