Slosarski Max, Ordookhanian Christ, Amidon Ryan F, Lee Edward, Markarian Tedrik, Kaloostian Paul
School of Medicine, Idaho College of Osteopathic Medicine, Meridian, USA.
Internal Medicine, University of California, Riverside School of Medicine, Riverside, USA.
Eur J Case Rep Intern Med. 2025 Mar 10;12(4):005247. doi: 10.12890/2025_005247. eCollection 2025.
Managing electrolyte abnormalities is one of the cornerstones of properly caring for and managing hospitalized patients. Typically, electrolyte derangements are managed by direct repletion, volume status correction, or hemodialysis; however, the persistence of electrolyte abnormalities despite utilizing appropriate initial strategies requires further investigation.
A 72-year-old male presented to the emergency department with weakness 2 months post-exploratory laparotomy with ileostomy for small bowel perforation complicated by intra-abdominal infection. The patient was treated for sepsis and imaging revealed intra-abdominal and abdominal wall abscesses. After drainage, recovery was complicated by treatment of refractory hypomagnesemia in the context of zinc supplementation.
If initial electrolyte repletion measures do not provide the intended benefit, investigating secondary causes of refractory electrolyte abnormalities is necessary. While hypomagnesemia is one of the least common electrolyte derangements seen within the general acute care hospital setting, in facilities with relatively high volumes of bariatric or gastrointestinal surgical patients, keeping the phenomenon of zinc-induced hypomagnesemia in mind becomes more crucial due to its frequent use in those settings.
This case highlights the effects of excess high-dose zinc supplementation in a patient without zinc deficiency in the postoperative period who developed treatment-resistant hypomagnesemia due to zinc-induced impairment of magnesium absorption as well as gastrointestinal and renal losses.
Zinc supplementation can cause hypomagnesemia.
管理电解质异常是妥善护理和管理住院患者的基石之一。通常，电解质紊乱通过直接补充、纠正容量状态或血液透析来处理；然而，尽管采用了适当的初始策略，电解质异常仍然持续，这需要进一步调查。
一名72岁男性在因小肠穿孔并发腹腔内感染行剖腹探查术并造口术后2个月，因虚弱就诊于急诊科。患者接受了败血症治疗，影像学检查发现腹腔内和腹壁脓肿。引流后，在补充锌的情况下，难治性低镁血症的治疗使恢复过程变得复杂。
如果初始电解质补充措施未达到预期效果，则有必要调查难治性电解质异常的继发原因。虽然低镁血症是一般急性护理医院环境中最不常见的电解质紊乱之一，但在肥胖或胃肠外科手术患者数量相对较多的机构中，由于锌在这些环境中的频繁使用，牢记锌诱导的低镁血症现象变得更为关键。
本病例突出了在术后无锌缺乏的患者中过量补充高剂量锌的影响，该患者因锌诱导的镁吸收受损以及胃肠道和肾脏丢失而出现难治性低镁血症。
补充锌可导致低镁血症。
