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Abstract: SA-PO518

Platinum Based Chemotherapy Related Hypomagnesemia Treated With Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors in Non-Diabetic Cancer Patients

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical


  • Hammad, Nour, University Hospitals, Cleveland, Ohio, United States
  • Rashidi, Arash, University Hospitals, Cleveland, Ohio, United States

Platinum based chemotherapy, such as cisplatin and carboplatin, is known to cause hypomagnesemia by renal magnesium wasting. Sodium glucose co-transporter 2 (SGLT2) inhibitors are new class of type 2 diabetes drugs with growing popularity because of their renal and heart benefits beside their diabetes indication. This class of medications was found to elevate serum magnesium levels by 0.15-0.24 mg/dl in prior meta-analysis. We present three patients with refractory hypomagnesemia related to cisplatin/carboplatin who were treated with SGLT2 inhibitors with marked improvement in serum magnesium levels.

Case Description

Case 1:
75 year old female with history of stage 3C serous ovarian cancer status post debulking procedure and chemotherapy with docetaxol and carboplatin. She had multiple electrolyte abnormalities including hypokalemia and hypomagnesemia that partially improved after ostomy closure. She continued to have refractory hypomagnesemia treated with oral and intravenous magnesium.

Case 2
57 year old female with history of stage 3C endothelial varian cancer status post debulking procedure and chemotherapy with carboplatin and docetaxol. She developed hypomagnesemia requiring intravenous and oral magnesium replacements.

Case 3:
57 year old male with T2N3M0 left supraglottic cancer treated with cisplatin, 5-flourouracil, and pembrolizumab. He was noted to have hypokalemia and hypomagnesemia which was dependent on oral and intravenous magnesium.

All three patients were later started on amiloride, however continued to be dependent on oral and intravenous magnesium despite increasing amiloride dose. They were later started on dapagliflozin and had normalization of serum magnesium off intravenous supplementation.


Hypomagnesemia can occur at any time with platinum based chemotherapy and can last after discontinuation of the drug. Our patients developed refractory hypomagnesemia on oral and intravenous magnesium supplementation in addition to incremental doses of amiloride. Daptogliflozin was started and patient had improved magnesium level with discontinuation of intravenous supplementation.