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Abstract: SA-PO702

Gitelman-Like Syndrome Associated with Seizure Secondary to Chronic Proton Pump Inhibitor Use and Alcohol Consumption: Case Report of Undetectable Magnesium

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • de Souza, Sergio Pinto, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Dultra, Isadora Goncalves, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Santos, Ludmila B S, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Requião, Maiara Vilas boas, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Gomes, Marcel Miranda Dantas, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Lopes, Marcelo, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Conceição, Luis Miranda, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Coelho, Fernanda O., Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Batista, Paulo benigno Pena, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Passos, Rogerio, Hospital Sao Rafael, Salvador, Bahia, Brazil
  • Silveira, Marcelo Duarte, Hospital Sao Rafael, Salvador, Bahia, Brazil
Introduction

Magnesium (Mg2+) is the second most common intracellular cation, acting as a cofactor in over 300 metabolic reactions. Magnesium metabolism depends on integrated actions between the kidney and intestine. There are descriptions of reductions in intestinal and renal absorptive capacities by use of a proton pump inhibitor (PPI) as well as by alcohol consumption, but undetectable serum magnesium is not common. We describe a case of severe hypomagnesemia in a patient who has been a chronic user (for 8 years) of PPIs and consumes alcohol daily.

Case Description

Male, 73 years old, hypertensive, diabetic, sarcopenic admitted due to generalized tonic-clonic seizure. He was using antihypertensive drugs (Atenolol 50 mg / day; Lisonopril 20mg / day and Amlodipine 5 mg / day), in addition to the chronic use of Omeprazole (40 mg / day). He had a habit of daily drinking (01 bottle of wine a day) and eating meat, with low intake of vegetables and legumes. In admission exams, the following were identified in the blood: Hb: 12.3 g/dl, creatinine (Cr): 1.0 mg/dl, Mg less than 0.1 mmol/L (RV 0.7 – 1.2 mmol/L) potassium 3.6 mEq/L (RV 3.5 – 5.0 mEq/L), sodium 139 mEq/L, chloride 106 mmol/L, HCO3-: 27.2 mEq/L, PTH: 82.9 pg/L ml. Urinary tests showed: Volume 1.5 L/day; uMg: 2.16 mmol/day; Mg excretion fraction (FeMg) 6%; uCa 13.5 mg/day; uNa 100mEq/day; uCr 46.6mg/dl; uK 11.8 mEq/L; FeK 7%.
Omeprazole was suspended and intravenous Mg replacement was started, followed by maintenance with oral Mg replacement. Levels normalized after 2 weeks. The patient was discharged from the hospital using oral Mg at a dose of 260 mg/day of elemental Mg for outpatient follow-up.

Discussion

We describe a case of severe hypomagnesemia in an elderly patient with a history of chronic use of PPIs associated with daily alcohol consumption and low intake of legumes. He also had metabolic alkalosis and hypocalciuria, findings compatible with Gitelman-like syndrome. There was normalization and maintenance of adequate levels of magnesium after discontinuation of PPI and alcohol consumption, demonstrating the role of these factors in this disorder.