Thiazide and proton pump inhibitor-induced severe hypomagnesemia and hypocalcemia: case report
DOI:
https://doi.org/10.11606/issn.1679-9836.v100i5p514-518Keywords:
Magnesium deficiency, Hpocalcemia, Hypoparathyroidism, Omeprazole, Diuretics, Proton pump inhibitorsAbstract
Introduction: Proton pump inhibitors (PPIs) and thiazide diuretics are medications frequently used in primary care. Objective: to report a case of a patient with thiazide and proton pump inhibitor-induced severe hypomagnesemia and hypocalcemia and to review its etiology and pathophysiology, besides the measures that can be carried out to reduce the risk of these abnormalities. Case presentation: A 69-year-old man came to the clinic due to involuntary muscle contractions and progressive walking difficulties for 3 months. He had been taking omeprazole 20 mg / day for 20 years and hydrochlorothiazide 25 mg/ day for 2 years. On physical examination, he showed signs of neuromuscular hyperexcitability (fasciculations, muscle spasms, positive Chvostek and Trousseau sign). Laboratory tests indicated severe hypomagnesaemia and hypocalcemia, with parathormone concentrations inappropriately within the normal range. The patient was hospitalized and, with magnesium and calcium replacement and medication discontinuation, presented permanent resolution of the condition. Conclusion: Severe hypomagnesemia may be a complication of long-term administration of proton pump inhibitors (PPIs) and thiazide diuretics. PPIs cause a reduction in the active magnesium intestinal absorption pathway, while thiazides increase renal magnesium excretion. Severe hypomagnesaemia often leads to hypocalcemia by inducing a reduction in the secretion and action of parathyroid hormone. To avoid this potentially serious side effect, we recommend some precautions to be followed when a patient must be treated with a gastric acid suppressant and a thiazide.
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