# Thinking Outside the Box: A Case of Persistent Symptomatic Hypomagnesemia

## TL;DR

This paper discusses a case where long-term use of proton pump inhibitors caused severe low magnesium levels in a 78-year-old woman.

## Contribution

The paper highlights PPIs as a potential cause of hypomagnesemia and advocates for magnesium monitoring in long-term users.

## Key findings

- A 78-year-old woman's hypomagnesemia was traced to proton pump inhibitor use.
- PPIs may cause hypomagnesemia even when used alone.
- Systematic magnesium monitoring is recommended for long-term PPI users.

## Abstract

Although present in a significant number of people, hypomagnesemia is still an undervalued diagnosis. Therefore, its awareness and comprehensive etiological investigation become imperative. Among its multiple possible causes, drug iatrogenesis plays an important and often overlooked role. Here, we present a case of a 78-year-old female with recurrent bouts of severe hypomagnesemia of unknown origin, which, after an extensive study, was determined to be induced by proton pump inhibitors (PPIs). As such, our goal is to raise awareness of the potential risk of this side effect even in monotherapy, as well as to elucidate its underlying mechanisms, which are still not fully understood. Furthermore, it is intended to foster a systematic therapeutic review in these patients and raise discussion about the potential benefits of systematic magnesium monitoring in patients on long-term PPIs.