Department of Internal Medicine, Hospital Italiano de Buenos Aires, Teniente General Perón 4190 avenue, Buenos Aires, Argentina.
Pharmacology Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
Intern Emerg Med. 2021 Apr;16(3):711-717. doi: 10.1007/s11739-020-02501-1. Epub 2020 Oct 1.
Proton pump inhibitors (PPI)-related hypomagnesemia is a potentially life-threatening adverse event first described in 2006. PPIs are widely used in the general population. Information regarding prevalence and risk factors is scarce. We conducted a cross-sectional study in inpatients to evaluate prevalence and associated factors with hypomagnesemia in chronic PPIs users. This is a cross-sectional study of hospitalized adult patients with chronic use of PPIs from January 01, 2012, to December 31, 2018. Chronic use was defined as taking PPIs at least 6 months before hospital admittance. Data were collected from informatized medical records from a University Hospital (Hospital Italiano de Buenos Aires). Hypomagnesemia was defined as a value equal to or less than 1.7 mg/dl. The first hospitalization measurement was retrieved. Thirty-six percent of patients (95% CI 30-43) with chronic PPI use presented hypomagnesemia at admission. Patients with hypomagnesemia presented a higher prevalence of chronic kidney disease (18.6% vs 8%, p < 0.05), more use of oral magnesium supplementation (20.9% vs 8%, p < 0.05), use of corticosteroids (32.6% vs 19.3%, p = 0.06) and calcineurin inhibitors (17.4% vs 6.7%, p < 0.05). Regarding laboratory findings, they presented lower hematocrit (28.7% vs 32.8%, p < 0.05), phosphatemia (3 mg/dl vs 3.4 mg/dl, p < 0.05), natremia (135 mg/dl vs 136 mg/dl, p < 0.05) and albumin levels (2.8 g/dl vs 3.2 g/dl p < 0.05) when compared to those who presented normomagnesemia. Hypocalcemia was more frequent among patients with hypomagnesemia (57% vs 38.7%, p < 0.05). In the multivariate analysis, hyponatremia, decreasing levels of hematocrit (odds ratio, OR 0.93-CI 95% 0.88-0.98) and malignant bone compromise (OR 2.83-CI 95% 1.04-7.7) were associated with hypomagnesemia. Adult patients with long-term use of PPIs have a high prevalence of hypomagnesemia. Increasing age, female sex, concomitant use of drugs that impair tubular function and chronic kidney disease may enhance this phenomenon. Anemia, hyponatremia and malignant bone compromise were associated factors with PPIs-related hypomagnesemia.
质子泵抑制剂（PPI）相关的低镁血症是一种潜在的危及生命的不良事件，于 2006 年首次描述。PPI 广泛用于普通人群。关于其患病率和危险因素的信息很少。我们对住院患者进行了一项横断面研究，以评估慢性 PPI 使用者低镁血症的患病率和相关因素。这是一项对 2012 年 1 月 1 日至 2018 年 12 月 31 日期间使用 PPI 的慢性住院成年患者的横断面研究。慢性使用定义为在入院前至少服用 PPI 6 个月。数据来自布宜诺斯艾利斯意大利医院的信息化病历。低镁血症定义为等于或低于 1.7mg/dl 的值。检索了第一次住院测量值。36%（95%CI 30-43）接受慢性 PPI 治疗的患者在入院时出现低镁血症。低镁血症患者的慢性肾脏病患病率更高（18.6% vs 8%，p<0.05），更常使用口服镁补充剂（20.9% vs 8%，p<0.05），使用皮质类固醇（32.6% vs 19.3%，p=0.06）和钙调神经磷酸酶抑制剂（17.4% vs 6.7%，p<0.05）。关于实验室发现，他们的红细胞压积（28.7% vs 32.8%，p<0.05）、血磷（3mg/dl vs 3.4mg/dl，p<0.05）、血钠（135mg/dl vs 136mg/dl，p<0.05）和白蛋白水平（2.8g/dl vs 3.2g/dl，p<0.05）低于镁正常患者。低镁血症患者更常出现低钙血症（57% vs 38.7%，p<0.05）。多变量分析显示，低钠血症、红细胞压积降低（比值比，OR 0.93-95%CI 0.88-0.98）和恶性骨侵犯（OR 2.83-95%CI 1.04-7.7）与低镁血症相关。长期使用 PPI 的成年患者低镁血症患病率较高。年龄增长、女性、同时使用损害肾小管功能的药物和慢性肾脏病可能会增强这种现象。贫血、低钠血症和恶性骨侵犯是 PPI 相关低镁血症的相关因素。
