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Extreme hypomagnesemia: characteristics of 119 consecutive inpatients

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Abstract

Extreme hypomagnesemia (hypoMg) can be encountered in many situations, but little data currently exist. Our aim is to describe the epidemiological, clinical, etiological characteristics, and the biological abnormalities of consecutive inpatients with extreme hypomagnesemia. In our observational monocentric study, between 1st July 2000 and April 2015, all inpatients with extreme hypomagnesemia, defined by at least one plasma magnesium concentration (PMg) below 0.3 mmol/L, were included. Demographic, clinical, biological characteristics and the drugs prescribed before the qualifying PMg measurement were retrospectively collected. 41,069 patients had at least one PMg assessment. The prevalence of extreme hypomagnesemia is 0.3% (119 inpatients). The median age is 70 years, 52% are women. The patients were mainly hospitalized in intensive care (n = 37, 31.1%), oncology (n = 21, 17.6%), gastroenterology (n = 18, 15.1%) and internal medicine (n = 16, 13.4%) departments. One hundred patients (84%) had a medical history of gastrointestinal disease (39% with bowel resections, 24% with stoma), and 50 (42%) had a cancer history. The drugs most commonly prescribed (known to induce hypoMg) are proton pump inhibitors (PPI) (n = 77, 70%), immunosuppressive regimens (n = 25, 22.5%), platinum salt-based chemotherapies (n = 19, 17.1%), and diuretics (n = 22, 19.8%). The suspected causes of hypomagnesemia are often multiple, but drugs (46%, including PPI in 19%) and chronic gastrointestinal disorders (37%) are prominent. Associated electrolyte disturbances include hypocalcemia (77%) and mild hypokalemia (51%). The 1-month mortality from all causes is 16%. Extreme hypomagnesemia is rare in inpatients, and is frequently associated with severe hypocalcemia. Digestive disorders and drugs are the main contributory causes.

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Abbreviations

A:

Albumin

CK:

Creatine kinase

Cac :

Corrected plasma calcium concentration

Cam :

Measured plasma calcium concentration

CDW:

Clinical data warehouse

CERHUPO:

Comité d’Ethique pour les Recherches non interventionnelles Hôpitaux Universitaires Paris Ouest

CNIL:

Commission Nationale de l’Informatique et des Libertés

EKG:

Electrocardiogram

EGFR:

Epidermal growth factor receptor

eGFR:

Estimated glomerular filtration rate

HEGP:

Hôpital Européen Georges Pompidou

HypoMg:

Hypomagnesemia

IQR:

Interquartile range

MCV:

Mean corpuscular volume

PMg :

Plasma magnesium concentration

P:

Protein

PPI:

Proton pump inhibitors

PTH:

Parathormone

RBC:

Red blood cells

References

  1. Ayuk J, Gittoes NJ (2014) Contemporary view of the clinical relevance of magnesium homeostasis. Ann Clin Biochem 51(Pt 2):179–188

    Article  Google Scholar 

  2. William JH, Danziger J (2016) Proton-pump inhibitor-induced hypomagnesemia: current research and proposed mechanisms. World J Nephrol 5(2):152–157

    Article  Google Scholar 

  3. Cheungpasitporn W, Thongprayoon C, Kittanamongkolchai W et al (2015) Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies. Ren Fail 37(7):1237–1241

    Article  CAS  Google Scholar 

  4. Park CH, Kim EH, Roh YH, Kim HY, Lee SK (2014) The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis. PLoS One 9(11):e112558

    Article  CAS  Google Scholar 

  5. Van Ende C, Van Laecke S, Marechal C et al (2014) Proton-pump inhibitors do not influence serum magnesium levels in renal transplant recipients. J Nephrol 27(6):707–711

    Article  CAS  Google Scholar 

  6. Lameris AL, Hess MW, van Kruijsbergen I, Hoenderop JG, Bindels RJ (2013) Omeprazole enhances the colonic expression of the Mg2+ transporter TRPM6. Pflüg Arch Eur J Physiol 465(11):1613–1620

    Article  CAS  Google Scholar 

  7. Koulouridis I, Alfayez M, Tighiouart H et al (2013) Out-of-hospital use of proton pump inhibitors and hypomagnesemia at hospital admission: a nested case-control study. Am J Kidney Dis 62(4):730–737

    Article  CAS  Google Scholar 

  8. Martin BJ, Milligan K (1987) Diuretic-associated hypomagnesemia in the elderly. Arch Intern Med 147(10):1768–1771

    Article  CAS  Google Scholar 

  9. Goren MP (2003) Cisplatin nephrotoxicity affects magnesium and calcium metabolism. Med Pediatr Oncol 41(3):186–189

    Article  Google Scholar 

  10. Lajer H, Bundgaard H, Secher NH, Hansen HH, Kjeldsen K, Daugaard G (2003) Severe intracellular magnesium and potassium depletion in patients after treatment with cisplatin. Br J Cancer 89(9):1633–1637

    Article  CAS  Google Scholar 

  11. Jiang D, Dennis K, Steinmetz A, Clemons M, Asmis TR, Goodwin RA et al (2016) Management of epidermal growth factor receptor inhibitor-induced hypomagnesemia: a systematic review. Clin Colorectal Cancer 15(3):e117–e123

    Article  Google Scholar 

  12. Bahr NC, Rolfes MA, Musubire A, Nabeta H, Williams DA, Rhein J et al (2014) Standardized electrolyte supplementation and fluid management improves survival during amphotericin therapy for Cryptococcal meningitis in resource-limited settings. Open Forum Infect Dis Internet 1(2):ofu070

    Google Scholar 

  13. Lee CH, Kim GH (2007) Electrolyte and acid-base disturbances induced by calcineurin inhibitors. Electrolyte Blood Press 5(2):126–130

    Article  CAS  Google Scholar 

  14. Rodrigues N, Santana A, Guerra J et al (2017) Serum magnesium and related factors in long-term renal transplant recipients: an observational study. Transplant Proc 49(4):799–802

    Article  CAS  Google Scholar 

  15. Pham PC, Pham PA, Pham S, Pham PT, Pham PM, Pham PT (2014) Hypomagnesemia: a clinical perspective. Int J Nephrol Renov Dis 7:219–230

    Article  CAS  Google Scholar 

  16. Kingston ME, Al-Siba’i MB, Skooge WC (1986) Clinical manifestations of hypomagnesemia. Crit Care Med 14:950–954

    Article  CAS  Google Scholar 

  17. Csako G, Rehak NN, Elin RJ (1997) Falsely high ionized magnesium results by an ion-selective electrode method in severe hypomagnesemia. Eur J Clin Chem Clin Biochem 35(9):701–709

    PubMed  CAS  Google Scholar 

  18. Wilkinson A (2011) An interesting case that included visual hallucinations in a patient with severe hypomagnesaemia and hypocalcaemia. BMJ Case Rep. https://doi.org/10.1136/bcr.10.2011.5051

    Article  PubMed  PubMed Central  Google Scholar 

  19. Leicher CR, Mezoff AG, Hyams JS (1991) Focal cerebral deficits in severe hypomagnesemia. Pediatr Neurol 7(5):380–381

    Article  CAS  Google Scholar 

  20. Cheungpasitporn W, Thongprayoon C, Qian Q (2015) Dysmagnesemia in hospitalized patients: prevalence and prognostic importance. Mayo Clin Proc 90(8):1001–1010

    Article  CAS  Google Scholar 

  21. Wong ET, Rude RK, Singer FR, Shaw ST (1983) A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients. Am J Clin Pathol 79:348–352

    Article  CAS  Google Scholar 

  22. Chernow B, Bamberger S, Stoiko M et al (1989) Hypomagnesemia in patients in postoperative intensive care. Chest 95(2):391–397

    Article  CAS  Google Scholar 

  23. Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ (2013) Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med 126(3):256–263

    Article  CAS  Google Scholar 

  24. Whang R, Ryder KW (1990) Frequency of hypomagnesemia and hypermagnesemia: requested vs routine. JAMA 263:3063–3064

    Article  CAS  Google Scholar 

  25. Ayuk J, Gittoes NJ (2011) How should hypomagnesaemia be investigated and treated? Clin Endocrinol (Oxf) 75(6):743–746

    Article  CAS  Google Scholar 

  26. Ayuk J, Gittoes NJ (2014) Treatment of hypomagnesemia. Am J Kidney Dis 63(4):691–695

    Article  CAS  Google Scholar 

  27. Hoorn EJ, Zietse R (2012) Disorders of calcium and magnesium balance: a physiology-based approach. Pediatr Nephrol 28(8):1195–1206

    Article  Google Scholar 

  28. Boyd JC, Bruns DE, Wills MR (1983) Frequency of hypomagnesemia in hypokalemic states. Clin Chem 29:178–179

    PubMed  CAS  Google Scholar 

  29. Mennes P, Rosenbaum R, Martin K, Slatopolsky E (1978) Hypomagnesemia and impaired parathyroid hormone secretion in chronic renal disease. Ann Intern Med 88(2):206–209

    Article  CAS  Google Scholar 

  30. Martin KJ, Gonzalez EA, Slatopolsky E (2009) Clinical consequences and management of hypomagnesemia. J Am Soc Nephrol 20(11):2291–2295

    Article  CAS  Google Scholar 

  31. Badran AM, Joly F, Messing B (2004) L’hypomagnésémie: causes, manifestations et traitement. Nutr Clin Metab 18(3):127–130

    Article  CAS  Google Scholar 

  32. Cundy T, Dissanayake A (2008) Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 69(2):338–341

    Article  CAS  Google Scholar 

  33. Janett S, Camozzi P, Peeters GG, Lava SA, Simonetti GD, Goeggel Simonetti B et al (2015) Hypomagnesemia induced by long-term treatment with proton-pump inhibitors. Gastroenterol Res Pract 2015:1–7

    Article  Google Scholar 

  34. William JH, Danziger J (2016) Magnesium deficiency and proton-pump inhibitor use: a clinical review. J Clin Pharmacol 56(6):660–668

    Article  CAS  Google Scholar 

  35. Wolf F, Hilewitz A (2014) Hypomagnesaemia in patients hospitalised in internal medicine is associated with increased mortality. Int J Clin Pract 68(1):111–116

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all the physicians, biologists and patients involved in the study, and Professor Pascal Houillier (Renal Physiology Department, Georges Pompidou European Hospital) for their critical reading of the manuscript.

Funding

No specific financial support was obtained

Author information

Authors and Affiliations

  1. Service de Médecine Interne, Internal medicine Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015, Paris, France

    Geoffrey Cheminet, Brigitte Ranque, Amélie Passeron, Adrien Michon, Gonzalo De Luna, Jacques Pouchot & Jean-Benoît Arlet

  2. Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France

    Geoffrey Cheminet, Gabrielle Clain, Anne-Sophie Jannot, Brigitte Ranque, Amélie Passeron, Adrien Michon, Gonzalo De Luna, Jean-Luc Diehl, Stéphane Oudard, Christophe Cellier, Alexandre Karras, Caroline Prot-Bertoye, Jacques Pouchot & Jean-Benoît Arlet

  3. Medical Information Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Gabrielle Clain & Anne-Sophie Jannot

  4. Medical Intensive Care Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Jean-Luc Diehl

  5. Oncology Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Stéphane Oudard

  6. Gastroenterology Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Christophe Cellier

  7. Nephrology Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Alexandre Karras

  8. Biochemistry Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Benoit Vedié

  9. Renal Physiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France

    Caroline Prot-Bertoye

Authors
  1. Geoffrey Cheminet
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  2. Gabrielle Clain
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  3. Anne-Sophie Jannot
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  4. Brigitte Ranque
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  6. Adrien Michon
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  7. Gonzalo De Luna
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  8. Jean-Luc Diehl
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  9. Stéphane Oudard
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  10. Christophe Cellier
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  13. Caroline Prot-Bertoye
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  14. Jacques Pouchot
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  15. Jean-Benoît Arlet
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Corresponding author

Correspondence to Jean-Benoît Arlet.

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Conflict of interest

None of the authors report any real or perceived conflict of interest disclosure regarding this study. The corresponding author signs on behalf of all the co-authors.

Ethical statements

The study was approved by our local institutional review board (CERHUPO: Comité d’Ethique pour les Recherches non interventionnelles Hôpitaux Universitaires Paris Ouest) and the CNIL (Commission Nationale de l’Informatique et des Libertés).

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of retrospective study formal consent is not required.

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Cheminet, G., Clain, G., Jannot, AS. et al. Extreme hypomagnesemia: characteristics of 119 consecutive inpatients. Intern Emerg Med 13, 1201–1209 (2018). https://doi.org/10.1007/s11739-018-1898-7

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  • DOI: https://doi.org/10.1007/s11739-018-1898-7

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