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Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication

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World Journal of Gastroenterology 2017年第37期23卷 6907-6910页

作者： Synne Semb Frederik Helgstrand Flemming Hjorne Peter Bytzer Department of Gastroenterology Zealand University Hospital Department of Surgery Zealand University Hospital Department of Clinical Medicine University of Copenhagen

Magnesium deficiency can cause a variety of symptoms, including potentially life-threatening complications such as seizures, cardiac arrhythmias and secondary electrolyte disturbances. hypomagnesemia can be a serious adverse effect to proton pump inhibitor(PPI) therapy, which is worrying due to the widespread use of PPIs. Current evidence suggest that the mechanism of PPI induced hypomagnesemia is impaired intestinal magnesium absorption. In this report, we present the case of a long-term PPI user with persistent hypomagnesemia with severe symptoms at presentation. He was unable to stop PPI treatment because of severe reflux symptoms, and was dependent on weekly intravenous magnesium infusions, until his magnesium levels finally normalized without the need for supplementation after a successful laparoscopic fundoplication.

关键词： hypomagnesemia 质子泵禁止者 Gastroesophageal 倒流疾病药不利效果 Laparoscopic fundoplication

hypomagnesemia with Secondary Hypocalcemia Linked to a Novel TRPM6 Gene Mutation

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Open Journal of Pediatrics 2016年第4期6卷 290-294页

作者： Amel Tej Bernd Dworniczak Asma Marzouk Najla Soyah Samia Tilouche Moez Gribaa Jihène Bouguila Lamia Boughamoura Pediatric Department Farhat Hached Sousse Tunisia Department of Human Genetics Westfaelishe Wilhelms Universitat Münster Germany Department of Human Genetics Farhat Hached Sousse Tunisia Medical faculty Ibn Jazzar University of Sousse Sousse Tunisia

hypomagnesemia with secondary hypocalcemia (HSH) is a rare inherited disorder, characterized by extremely low levels of serum magesium associated with symptomatic hypocalcemia. HSH manifests in the new born period with neurological symptoms, including generalized seizures, which are refractory to anticonvulsant treatment. In this disorder, the basic abnormality is the defective intestinal absorption of magnesium. Mutations in TRPM6, the gene encoding the transient receptor potential cation channel subfamily member 6 have been found to be responsible for this disease. We report on a four-month-old Tunisian girl who presented with convulsions. Laboratory evaluation yielded extremely low serum magnesium levels, low calcium levels, and abnormal PTH levels. The diagnosis of HSH was confirmed by mutation analysis which identified the novel mutation c.1307A >G in exon 11 of TRPM6 (Lys436Arg). Our patient was homozygous for this mutation. Prenatal diagnosis was done during second pregnancy. DNA from trophoblast biopsy showed the same mutation as the proband.

关键词： Magnesium hypomagnesemia Hypocalcemia Convulsion TRPM6

Domino effect of hypomagnesemia on the innate immunity of Crohn's disease patients

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World Journal of Diabetes 2014年第4期5卷 527-535页

作者： Saleh A Naser Almatmed Abdelsalam Saisathya Thanigachalam Abed S Naser Karel Alcedo Burnett School of Biomedical Sciences College of Medicine University of Central Florida Orlando FL 32816 United States

Digestive diseases play major role in development and complications of other disorders including *** example,Crohn’s disease(CD)is an inflammatory bowel disease associated with Mycobacterium avium subspecies *** inflammation is a complex process that involves the activity of both innate and adaptive immune *** lesions are primarily due to T cell response,however;innate immune response has a significant role in initiating its ***-like receptors and NOD-like receptors promote the activity of nuclear factor(NF)-κB pathway for cytokines *** results in the production of high levels of tumor necrosis factor-α,interleukin(IL)-1βand ***,intestinal inflammation of CD is related to increased activity of NMDA receptors and the release of substance *** magnesium homeostasis in CD is a frequent finding in CD,Diabetes and *** loss of such a major mineral affects many physiological processes in the body including its role as an *** review aims to(1)describe the significance of hypomagnesemia in the release of pro-inflammatory mediators in CD;(2)demonstrate effects of magnesium on pathways like NF-κB;(3)address the role of hypomagnesemia in the activity of CD;and(4)examine possible future research to establish a standard magnesium supplementation strategy;helping patients with CD or other disorders to maintain a sustained remission.

关键词： Diabetes Crohn’s disease hypomagnesemia Inflammatory bowel disease Mycobacterium paratuberculosis

Early diagnosis of Gitelman syndrome in a young child:A case report

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World Journal of Clinical Cases 2022年第9期10卷 2844-2850页

作者： Chun-Yen Wu Ming-Hsein Tsai Chia-Chun Chen Chuan-Hong Kao Department of Pediatrics Far Eastern Memorial HospitalNew Taipei City 220Taiwan Department of Internal Medicine Shin-Kong Wu Ho-Su Memorial HospitalTaipei 111Taiwan

BACKGROUND Gitelman syndrome(GS)is an autosomal recessive renal tubular disorder characterized by renal wasting hypokalemia,metabolic alkalosis,hypomagnesemia,and *** is usually caused by mutations in the gene SLC12A3,which encodes the thiazide-sensitive Na-Cl *** is not usually diagnosed until late childhood or *** SUMMARY Here,we report the case of a one-year-old girl who was brought to the emergency department due to persistent vomiting for two *** admission to our hospital,generalized weakness was observed,and laboratory investigations revealed severe hypokalemia(1.9 mmol/L).However,persistent hypokalemia was observed during outpatient *** of the GS phenotype was assessed via the patient’s clinical presentation,family history,and biochemical analysis of blood and *** genetic analysis was performed for her and her family by exon-wide sequencing analysis of the gene *** genetic diagnosis of GS was established in the Taiwan region family with three affected individuals,two of whom were children(7 years/17 years)without obvious symptoms,with the youngest being only one year old(patient in our case).CONCLUSION We successfully demonstrated the early diagnosis of GS using family genetic *** instances of hypokalemia should not be neglected,as early detection of GS with suitable treatment can prevent patients from potentially lifethreatening complications.

关键词： Children Hypokalemia hypomagnesemia SLC12A3 Gitelman syndrome Case report

Gitelman syndrome:A case report

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World Journal of Clinical Cases 2022年第17期10卷 5893-5898页

作者： Shi-Yuan Chen Ning Jie Department of Endocrinology Longhua Central HospitalShenzhen 518110Guangdong ProvinceChina

BACKGROUND Gitelman syndrome(GS)is an autosomal recessive salt-losing renal tubulopathy arising from mutations in the thiazide-sensitive Na-Cl cotransporter *** to its low incidence and lack of awareness,GS can be easily misdiagnosed or missed in *** SUMMARY A 24-year-old male presented with>4 years of repeated limb weakness without any *** previous day,the patient was bitten by ants and showed weakness of the lower *** patient had hypokalemia(1.66-2.83 mmol/L),hypomagnesemia(0.4 mmol/L),hypocalciuria(1.51-2.46 mmol/d),metabolic alkalosis(7.47-7.54),normal blood pressure,and increased activity of aldosterone and plasma renin activity(PRA)(PRA 6.4 and 16.45 ng/mL/h and aldosterone 330.64 and 756.82 pg/mL in the supine and upright position,respectively).In addition,SLCI2A3 gene mutation with GS was *** and intravenous supplementation with potassium and magnesium was *** magnesium returned to 0.48 mmol/L and serum potassium returned to 3.08 mmol/L,alleviating the patient’s fatigue *** GS should be considered in patients with hypokalemia complicated with *** testing is essential to confirm the diagnosis.

关键词： Gitelman syndrome Limb weakness Hypokalemia hypomagnesemia Hypocalciuria Genetic testing Case report

Clinical and genetic features of Kenny-Caffey syndrome type 2 with multiple electrolyte disturbances:A case report

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World Journal of Clinical Cases 2023年第10期11卷 2290-2300页

作者： Ning Yuan Lin Lu Xiao-Ping Xing Ou Wang Yue Jiang Ji Wu Ming-Hai He Xiao-Juan Wang Le-Wei Cao Department of Endocrinology Nanchong Central HospitalThe Second Clinical CollegeNorth Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Department of Endocrinology Key Laboratory of National health commissionPeking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical ScienceBeijing 100730China Department of Urology Nanchong Central HospitalThe Second Clinical CollegeNorth Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina

BACKGROUND Hypoparathyroidism,which can be sporadic or a component of an inherited syndrome,is the most common cause of *** hypocalcemia is accompanied by other electrolyte disturbances,such as hypokalemia and hypomagnesemia,then the cause,such as renal tubular disease,should be carefully *** SUMMARY An 18-year-old female visited our clinic because of short stature and facial deformities,including typical phenotypes,such as low ear position,depression of the nasal bridge,small hands and feet,and loss of *** lab results suggested normal parathyroid hormone but *** addition,multiple electrolyte disturbances were found,including hypokalemia,hypocalcemia and *** physical signs showed a short fourth metatarsal bone of both *** X-ray images showed cortical thickening of long bones and narrowing of the medulla of the *** computed tomography indicated calcification in the bilateral basal ***,the genetic investigation showed a de novo heterogenous mutation of“FAM111A”(c.G1706A:p.R569H).Through a review of previously reported cases,the mutation was found to be the most common mutation site in Kenny-Caffey syndrome type 2(KCS2)cases reported thus far(16/23,69.6%).The mutation was slightly more prevalent in females than in males(11/16,68.8%).Except for hypocalcemia,other clinical manifestations are *** As a rare autosomal dominant genetic disease of hypoparathyroidism,the clinical manifestations of KCS2 are atypical and *** girl presented with short stature,facial deformities and skeletal *** laboratory results revealed hypocalcemia as the main electrolyte *** though her family members showed normal phenotypes,gene detection was performed to find the mutation of the FAM111A gene and confirmed the diagnosis of KCS2.

关键词： Hypocalcemia hypomagnesemia Hypoparathyroidism Kenny-Caffey syndrome type 2 FAM111A gene Case report

Metabolic and Renal Protective Benefits of Magnesium Supplementation in the Long-Term Management of Patients with Type 2 Diabetes Mellitus

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Journal of Diabetes Mellitus 2023年第2期13卷 163-177页

作者： Richard Evers Katholi Marcella Rene Ervin Prairie Educational and Research Cooperative Department of Pharmacology Southern Illinois School of Medicine Springfield USA Prairie Educational and Research Cooperative Springfield USA

Magnesium deficiency is common in patients with type 2 diabetes mellitus (type 2 DM). When adequate magnesium supplementation is chronically given, patients with type 2 DM appear to have improved glucose control and may have delayed chronic complications. In addition, magnesium supplementation may slow the progression of chronic kidney disease (CKD) and decrease the risk of contrast-induced nephropathy in patients with type 2 DM. Keeping serum magnesium at 2.0 mEq/L or greater appears to accomplish these benefits for patients with type 2 DM. Periodically measuring serum magnesium and estimated glomerular filtration rate (eGFR) allows a physician to adjust the supplemental magnesium dose to accomplish these therapeutic goals while avoiding hypermagnesemia.

关键词： hypomagnesemia Contrast-Induced Nephropathy Renal Function SGLT2 Inhibitors Type 2 Diabetes Mellitus

Effect of prolonged omeprazole administration on segmental intestinal Mg2+ absorption in male Sprague-Dawley rats

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World Journal of Gastroenterology 2020年第11期26卷 1142-1155页

作者： Nasisorn Suksridechacin Punnisa Kulwong Siriporn Chamniansawat Narongrit Thongon Division of Physiology Department of Biomedical SciencesFaculty of Allied Health SciencesBurapha UniversityChonburi 20131Thailand Division of Anatomy Department of Biomedical SciencesFaculty of Allied Health SciencesBurapha UniversityChonburi 20131Thailand

BACKGROUND The exact mechanism of proton pump inhibitors(PPIs)-induced hypomagnesemia(PPIH) is largely unknown. Previous studies proposed that PPIH is a consequence of intestinal Mg2+ malabsorption. However, the mechanism of PPIs-suppressed intestinal Mg2+ absorption is under *** To investigate the effect of 12-wk and 24-wk omeprazole injection on the total,transcellular, and paracellular Mg2+ absorption in the duodenum, jejunum, ileum,and colon of male Sprague-Dawley *** The rats received 20 mg/kg·d subcutaneous omeprazole injection for 12 or 24 *** and urinary Mg2+, Ca2+, and PO43-levels were measured. The plasma concentrations of 1α,25-dihydroxyvitamin D3(1α,25(OH)2D3), parathyroid hormone(PTH), fibroblast growth factor 23(FGF-23), epidermal growth factor(EGF), and insulin were also observed. The duodenum, jejunum, ileum, and colon of each rat were mounted onto individual modified Using chamber setups to study the rates of total, transcellular, and paracellular Mg2+ absorption simultaneously. The expression of transient receptor potential melastatin 6(TRPM6) and cyclin M4(CNNM4) in the entire intestinal tract was also *** Single-dose omeprazole injection significantly increased the intraluminal p H of the stomach, duodenum, and jejunum. Omeprazole injection for 12 and 24 wk induced hypomagnesemia with reduced urinary Mg2+ excretion. The plasma Ca2+ was normal but the urinary Ca2+ excretion was reduced in rats with PPIH. The plasma and urinary PO43-levels increased in PPIH rats. The levels of1α,25(OH)2D3 and FGF-23 increased, whereas that of plasma EGF decreased in the omeprazole-treated rats. The rates of the total, transcellular, and paracellular Mg2+ absorption was significantly lower in the duodenum, jejunum, ileum, and colon of the rats with PPIH than in those of the control rats. The percent suppression of Mg2+ absorption in the duodenum, jejunum, ileum, and colon of the rats with PPIH compared with the control rats was 81.

关键词： Adverse effect Colon Mg2+absorption Proton pump inhibitors-induced hypomagnesemia Small intestine

Proton pump inhibitors and adverse effects in kidney transplant recipients: A meta-analysis

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World Journal of Transplantation 2019年第2期9卷 35-47页

作者： Boonphiphop Boonpheng Charat Thongprayoon Tarun Bathini Konika Sharma Michael A Mao Wisit Cheungpasitporn Department of Internal Medicine East Tennessee State University Johnson City TN37614 United States Division of Nephrology and Hypertension Department of Medicine Mayo Clinic Rochester MN55905 United States Department of Internal Medicine University of Arizona Tucson AZ85721 United States Department of Internal Medicine Bassett Medical Center Cooperstown NY13326 United States Division of Nephrology Department of Medicine University of Mississippi Medical Center Jackson MS39216 United States

BACKGROUND The adverse renal effects of proton pump inhibitors (PPIs) are increasingly recognized in both the general population and patients with chronic kidney disease. Several pharmacokinetic studies have also raised concerns regarding the interaction between PPIs and immunosuppressive drugs in transplant patients. Whether the adverse effects of PPIs have a clinical significance in kidney transplant recipients remains unclear. We performed this meta-analysis to assess the risk of adverse effects in kidney transplant recipients on PPI compared with those without PPI exposure. AIM To investigate the risk of acute rejection, graft loss, hypomagnesemia, renal dysfunction, and overall mortality in kidney transplant recipients on PPI compared with those without PPI exposure. METHODS A systematic review was conducted in MEDLINE, EMBASE, and Cochrane databases from inception through October 2018 to identify studies that evaluated the adverse effects of PPIs in kidney transplant recipients, including biopsyproven acute rejection, graft loss, hypomagnesemia, renal function, and overall mortality. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO, No. CRD42018115676. RESULTS Fourteen observational studies with 6786 kidney transplant recipients were enrolled. No significant association was found between PPI exposure and the risk of biopsy-proven acute rejection at ≥ 1 year [pooled odds ratio (OR), 1.25;95% confidence interval (CI), 0.82-1.91, I2 = 55%], graft loss at 1 year (pooled OR = 1.30, 95%CI: 0.75-2.24, I2 = 0%) or 1-year mortality (pooled OR = 1.53, 95%CI: 0.90-2.58, I2 = 34%). However, PPI exposure was significantly associated with hypomagnesemia (pooled OR = 1.56, 95%CI: 1.19-2.05, I2 = 27%). Funnel plots and Egger regression asymmetry test were performed and showed no publication bias. CONCLUSION PPI

关键词： Proton pump inhibitors Kidney Renal transplantation Meta-analysis hypomagnesemia Systematic reviews