Ray Evan C, Boyd-Shiwarski Cary R, Liu Pengfei, Novacic Danica, Cassiman David
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Molecular and Human Genetics, Baylor College of Medicine, Houston, TX.
Kidney Med. 2020 Apr 18;2(3):359-364. doi: 10.1016/j.xkme.2020.01.010. eCollection 2020 May-Jun.
In patients with urinary magnesium wasting, oral and intravenous supplementation often fail to adequately improve serum magnesium levels. Glucose intolerance and diabetes mellitus frequently accompany hypomagnesemia. Clinical trials examining inhibitors of the type 2 sodium glucose cotransporter (SGLT2) show small but significant increases in serum magnesium levels in diabetic patients. This report describes dramatic improvement in serum magnesium levels and associated symptoms after initiating SGLT2 inhibitor therapy in 3 patients with refractory hypomagnesemia and diabetes. Each patient received a different SGLT2 inhibitor: canagliflozin, empagliflozin, or dapagliflozin. One patient discontinued daily intravenous magnesium supplements and exhibited higher serum magnesium levels than had been achieved by magnesium infusion. 2 of the 3 patients exhibited reduced urinary fractional excretion of magnesium, suggesting enhanced tubular reabsorption of magnesium. These observations demonstrate that SGLT2 inhibitors can improve the management of patients with otherwise intractable hypomagnesemia, representing a new tool in this challenging clinical disorder.
在尿镁流失的患者中，口服和静脉补充镁剂往往无法充分提高血清镁水平。葡萄糖不耐受和糖尿病常伴有低镁血症。对2型钠-葡萄糖协同转运蛋白（SGLT2）抑制剂进行的临床试验表明，糖尿病患者的血清镁水平虽有小幅但显著的升高。本报告描述了3例难治性低镁血症和糖尿病患者在开始使用SGLT2抑制剂治疗后，血清镁水平及相关症状得到显著改善。每位患者使用了不同的SGLT2抑制剂：卡格列净、恩格列净或达格列净。1例患者停止每日静脉补充镁剂，其血清镁水平高于静脉输注镁剂时的水平。3例患者中有2例尿镁分数排泄减少，提示肾小管对镁的重吸收增强。这些观察结果表明，SGLT2抑制剂可改善难治性低镁血症患者的治疗，是应对这一具有挑战性的临床疾病的一种新工具。
