Weng Jiyan, Chen Wenjun, Zhu Mingjin
Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Department of Pharmacy, Xixi Hospital of Hangzhou, Hangzhou, China.
Galen Med J. 2024 May 1;13:e3350. doi: 10.31661/gmj.v13i.3350. eCollection 2024.
Seizure-like symptoms are rare in older patients without brain damage. Small bowel obstruction is a common clinical disorder for older patients that can cause electrolyte disturbances and nutritional disorders. Hypomagnesemia is a frequently overlooked electrolyte disorder. Moreover, magnesium deficiency can lead to severe seizure-like symptoms.
An 85-year-old man was admitted to the hospital with weakness and slow movement. Shortly after hospitalization, he experienced incomplete small bowel obstruction; thus, parenteral nutrition and intravenous esomeprazole were administered. When intestinal obstruction was relieved, the patient suddenly experienced seizure-like symptoms three times, and 24-h electroencephalogram did not capture any epileptiform pattern. After excluding other causes, we considered serum magnesium deficiency as a diagnosis. Low serum magnesium levels were related to a shortage of absorption due to small bowel obstruction, excess excretion of renal dysfunction, and the use of proton pump inhibitor. However, the exact mechanism underlying the hypomagnesemia-induced seizure-like activity remained unclear. After adjusting the nutritional support and magnesium supplementation, the patient's serum magnesium level returned to normal, and he was free of seizure-like activity.
Hypomagnesemia is often asymptomatic, but it can lead to severe seizure-like symptoms. It is important to pay attention to the serum magnesium level and nutritional intake in patients with an incomplete small bowel obstruction.
在无脑损伤的老年患者中，癫痫样症状较为罕见。小肠梗阻是老年患者常见的临床病症，可导致电解质紊乱和营养失调。低镁血症是一种常被忽视的电解质紊乱。此外，镁缺乏可导致严重的癫痫样症状。
一名85岁男性因虚弱和行动迟缓入院。住院后不久，他出现不完全性小肠梗阻；因此，给予了肠外营养和静脉注射埃索美拉唑。肠梗阻缓解后，患者突然三次出现癫痫样症状，24小时脑电图未捕捉到任何癫痫样波形。排除其他原因后，我们将血清镁缺乏作为诊断。血清镁水平低与小肠梗阻导致的吸收不足、肾功能不全导致的排泄过多以及质子泵抑制剂的使用有关。然而，低镁血症诱发癫痫样活动的确切机制仍不清楚。调整营养支持和补充镁后，患者的血清镁水平恢复正常，且未再出现癫痫样活动。
低镁血症通常无症状，但可导致严重的癫痫样症状。对于不完全性小肠梗阻患者，关注血清镁水平和营养摄入很重要。
