Shah Chintan V, Hammad Nour, Bhasin-Chhabra Bhavna, Rashidi Arash
Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida.
Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Kidney Med. 2023 Jul 1;5(9):100697. doi: 10.1016/j.xkme.2023.100697. eCollection 2023 Sep.
Sodium/glucose cotransporter 2 (SGLT2) inhibitors have demonstrated a class effect in improving serum magnesium levels in patients with diabetes. Additionally, recent reports have shown their promising beneficial effects in the treatment of refractory hypomagnesemia in patients with diabetes. However, their role in treating hypomagnesemia in patients without diabetes remains unexplored. Here, we report 4 cases of severe and refractory hypomagnesemia that showed dramatic improvement after initiating SGLT2 inhibitors in patients without diabetes. Case 1 had calcineurin inhibitor-associated severe hypomagnesemia. Cases 2, 3, and 4 had refractory hypomagnesemia associated with platinum-based chemotherapy with or without gastrointestinal losses. Case 1 was able to withdraw from high-dose oral magnesium supplementation. Cases 2 and 3 achieved independence from intravenous magnesium supplementation, whereas case 4 had decreased intravenous magnesium requirements. All the cases demonstrated sustainably improved serum magnesium levels. Withdrawal of SGLT2 inhibitors in case 4 resulted in worsening serum magnesium levels and intravenous magnesium requirements. The extraglycemic benefit of this group of medications not only suggests the need for further studies to better understand the effect of SGLT2 inhibitors on magnesium homeostasis but also supports expanded use in a larger patient population.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已显示出在改善糖尿病患者血清镁水平方面的类效应。此外，最近的报告显示它们在治疗糖尿病患者难治性低镁血症方面具有有前景的有益效果。然而，它们在治疗非糖尿病患者低镁血症中的作用仍未得到探索。在此，我们报告4例严重难治性低镁血症患者，在非糖尿病患者中启动SGLT2抑制剂后病情显著改善。病例1患有钙调神经磷酸酶抑制剂相关的严重低镁血症。病例2、3和4患有与铂类化疗相关的难治性低镁血症，伴有或不伴有胃肠道丢失。病例1能够停用高剂量口服镁补充剂。病例2和3不再需要静脉补充镁，而病例4的静脉镁需求量减少。所有病例的血清镁水平均持续改善。病例4停用SGLT2抑制剂导致血清镁水平恶化和静脉镁需求量增加。这类药物的血糖外益处不仅表明需要进一步研究以更好地了解SGLT2抑制剂对镁稳态的影响，也支持在更大患者群体中扩大使用。
