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Hypomagnesemia

Mizuho Morrison, DO and Matthieu DeClerck, MD
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Matt Delaney and Miz discuss the importance of low magnesium. They discuss clinically how it can increased myocardial irritability, lowers seizure threshold and increase neuronal hyperexcitability. They further discuss which patients are at high risk for this, workup and management and indications for repletion of this electrolyte.

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stacie o., 9692404 -

I attend a conference that stated all PPI's have a class action of blocking absorption of oral magnesium. Have you heard or seen any research to support this? The point they made in conference was that doing oral replacement will fail if still on oral PPI's medications. Thoughts?

Mike W., MD -

Thx Stacie for the question - will try and get an answer for you from our pharmacist extraordinaire Bryan Hayes.. Stay tuned...

Mike W., MD -

Stacie: from Bryan Hayes:
Article: William JH and Danziger, J. Magnesium Deficiency and Proton-Pump Inhibitor Use: A Clinical Review. The Journal of Clinical Pharmacology 2016, 56(6) 660–668

Long term PPI use can lead to hypomagnesemia in a small portion of those who take it. The mechanism is not well understood.
From the attached article: "Because the PPI effect is localized to the intestinal epithelial cell, and not to renal handling, intravenous magnesium rapidly improves magnesium serum concentrations, whereas oral magnesium repletion does not overcome the PPI effect."
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Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Assistant Professor of Emergency Medicine, Harvard Medical School
Attending Pharmacist, EM & Toxicology, MGH
President, American Board of Applied Toxicology (ABAT)

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Can't We All Just Get Along? Full episode audio for MD edition 204:00 min - 96 MB - M4AUC RAP January 2019 Written Summary 375 KB - PDF

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