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Proton-pump inhibitor use amongst patients with severe hypomagnesemia
Introduction: Long-term proton pump inhibitor (PPI) use has been associated with hypomagnesemia. It is unknown how frequently PPI use is implicated in patients with severe hypomagnesemia, and its clinical course or risk factors. Methods: All patients with severe hypomagnesemia from 2013 to 2016 in a...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922884/ https://www.ncbi.nlm.nih.gov/pubmed/36794273 http://dx.doi.org/10.3389/fphar.2023.1092476 |
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author | Seah, Sherry Tan, Yen Kheng Teh, Kevin Loh, Wann Jia Tan, Pei Ting Goh, Leng Chuan Malakar, Roy Debajyoti Aw, Tar Choon Lau, Chin Shern Dhalliwal, Trishpal Kui, Swee Leng Kam, Jia Wen Khoo, Joan Tay, Tunn Lin Tan, Eberta Au, Vanessa Soh, Shui Boon Zhang, Meifen King, Thomas F. Gani, Linsey Puar, Troy H. |
author_facet | Seah, Sherry Tan, Yen Kheng Teh, Kevin Loh, Wann Jia Tan, Pei Ting Goh, Leng Chuan Malakar, Roy Debajyoti Aw, Tar Choon Lau, Chin Shern Dhalliwal, Trishpal Kui, Swee Leng Kam, Jia Wen Khoo, Joan Tay, Tunn Lin Tan, Eberta Au, Vanessa Soh, Shui Boon Zhang, Meifen King, Thomas F. Gani, Linsey Puar, Troy H. |
author_sort | Seah, Sherry |
collection | PubMed |
description | Introduction: Long-term proton pump inhibitor (PPI) use has been associated with hypomagnesemia. It is unknown how frequently PPI use is implicated in patients with severe hypomagnesemia, and its clinical course or risk factors. Methods: All patients with severe hypomagnesemia from 2013 to 2016 in a tertiary center were assessed for likelihood of PPI-related hypomagnesemia using Naranjo algorithm, and we described the clinical course. The clinical characteristics of each case of PPI-related severe hypomagnesemia was compared with three controls on long-term PPI without hypomagnesemia, to assess for risk factors of developing severe hypomagnesemia. Results: Amongst 53,149 patients with serum magnesium measurements, 360 patients had severe hypomagnesemia (<0.4 mmol/L). 189 of 360 (52.5%) patients had at least possible PPI-related hypomagnesemia (128 possible, 59 probable, two definite). 49 of 189 (24.7%) patients had no other etiology for hypomagnesemia. PPI was stopped in 43 (22.8%) patients. Seventy (37.0%) patients had no indication for long-term PPI use. Hypomagnesemia resolved in most patients after supplementation, but recurrence was higher in patients who continued PPI, 69.7% versus 35.7%, p = 0.009. On multivariate analysis, risk factors for hypomagnesemia were female gender (OR 1.73; 95% CI: 1.17–2.57), diabetes mellitus (OR, 4.62; 95% CI: 3.05–7.00), low BMI (OR, 0.90; 95% CI: 0.86–0.94), high-dose PPI (OR, 1.96; 95% CI: 1.29–2.98), renal impairment (OR, 3.85; 95% CI: 2.58–5.75), and diuretic use (OR, 1.68; 95% CI: 1.09–2.61). Conclusion: In patients with severe hypomagnesemia, clinicians should consider the possibility of PPI-related hypomagnesemia and re-examine the indication for continued PPI use, or consider a lower dose. |
format | Online Article Text |
id | pubmed-9922884 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-99228842023-02-14 Proton-pump inhibitor use amongst patients with severe hypomagnesemia Seah, Sherry Tan, Yen Kheng Teh, Kevin Loh, Wann Jia Tan, Pei Ting Goh, Leng Chuan Malakar, Roy Debajyoti Aw, Tar Choon Lau, Chin Shern Dhalliwal, Trishpal Kui, Swee Leng Kam, Jia Wen Khoo, Joan Tay, Tunn Lin Tan, Eberta Au, Vanessa Soh, Shui Boon Zhang, Meifen King, Thomas F. Gani, Linsey Puar, Troy H. Front Pharmacol Pharmacology Introduction: Long-term proton pump inhibitor (PPI) use has been associated with hypomagnesemia. It is unknown how frequently PPI use is implicated in patients with severe hypomagnesemia, and its clinical course or risk factors. Methods: All patients with severe hypomagnesemia from 2013 to 2016 in a tertiary center were assessed for likelihood of PPI-related hypomagnesemia using Naranjo algorithm, and we described the clinical course. The clinical characteristics of each case of PPI-related severe hypomagnesemia was compared with three controls on long-term PPI without hypomagnesemia, to assess for risk factors of developing severe hypomagnesemia. Results: Amongst 53,149 patients with serum magnesium measurements, 360 patients had severe hypomagnesemia (<0.4 mmol/L). 189 of 360 (52.5%) patients had at least possible PPI-related hypomagnesemia (128 possible, 59 probable, two definite). 49 of 189 (24.7%) patients had no other etiology for hypomagnesemia. PPI was stopped in 43 (22.8%) patients. Seventy (37.0%) patients had no indication for long-term PPI use. Hypomagnesemia resolved in most patients after supplementation, but recurrence was higher in patients who continued PPI, 69.7% versus 35.7%, p = 0.009. On multivariate analysis, risk factors for hypomagnesemia were female gender (OR 1.73; 95% CI: 1.17–2.57), diabetes mellitus (OR, 4.62; 95% CI: 3.05–7.00), low BMI (OR, 0.90; 95% CI: 0.86–0.94), high-dose PPI (OR, 1.96; 95% CI: 1.29–2.98), renal impairment (OR, 3.85; 95% CI: 2.58–5.75), and diuretic use (OR, 1.68; 95% CI: 1.09–2.61). Conclusion: In patients with severe hypomagnesemia, clinicians should consider the possibility of PPI-related hypomagnesemia and re-examine the indication for continued PPI use, or consider a lower dose. Frontiers Media S.A. 2023-01-30 /pmc/articles/PMC9922884/ /pubmed/36794273 http://dx.doi.org/10.3389/fphar.2023.1092476 Text en Copyright © 2023 Seah, Tan, Teh, Loh, Tan, Goh, Malakar, Aw, Lau, Dhalliwal, Kui, Kam, Khoo, Tay, Tan, Au, Soh, Zhang, King, Gani and Puar. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Seah, Sherry Tan, Yen Kheng Teh, Kevin Loh, Wann Jia Tan, Pei Ting Goh, Leng Chuan Malakar, Roy Debajyoti Aw, Tar Choon Lau, Chin Shern Dhalliwal, Trishpal Kui, Swee Leng Kam, Jia Wen Khoo, Joan Tay, Tunn Lin Tan, Eberta Au, Vanessa Soh, Shui Boon Zhang, Meifen King, Thomas F. Gani, Linsey Puar, Troy H. Proton-pump inhibitor use amongst patients with severe hypomagnesemia |
title | Proton-pump inhibitor use amongst patients with severe hypomagnesemia |
title_full | Proton-pump inhibitor use amongst patients with severe hypomagnesemia |
title_fullStr | Proton-pump inhibitor use amongst patients with severe hypomagnesemia |
title_full_unstemmed | Proton-pump inhibitor use amongst patients with severe hypomagnesemia |
title_short | Proton-pump inhibitor use amongst patients with severe hypomagnesemia |
title_sort | proton-pump inhibitor use amongst patients with severe hypomagnesemia |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922884/ https://www.ncbi.nlm.nih.gov/pubmed/36794273 http://dx.doi.org/10.3389/fphar.2023.1092476 |
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