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Has omeprazole use been excluded? There have been two published case reports of this association with hypomagnesaemia and we have seen two cases locally that we hope to publish. See: Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. regards Edmund ----------------------------------------------------------------------------------------------------------- Dr Edmund Lamb PhD FRCPath Consultant Clinical Scientist (Biochemistry) and Head of Department Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, UK Tel: (44) 01227-766877 extn 74736 Fax: (44) 01227-783077 >>> Ian Young <[log in to unmask]> 10/01/07 9:53 pm >>> Profound hypomagnesaemiaDear all I look after two adult patients with significant recurrent hypomagnesaemia of this kind. I think that the cause is a selective renal Mg leak in both cases. The TRPM6 cases have a renal leak as well as the GI problem (see Nature Genetics 31, 171 - 174 (2002). The urinary Mg results are difficult to interpret, as renal Mg absorption may occur once serum Mg drops below a threshold value. The Nature paper above shows results of an Mg loading test which would be a useful investigation if you wanted to investigate further. (Coincidentally I saw a third patient this morning, who I have yet to investigate. His mother apparently had Mg problems and was on oral supplements for many years). If I cannot maintain serum Mg at a sufficient level top prevent symptoms on oral supplements, I use self-administered subcutaneous fluids containing Mg at home. I have a number of short bowel patients with electrolyte abnormalities on this regimen (as well as both the renal leak patients mentioned above) and it has been useful in preventing symptoms. Best wishes Ian IS Young Professor of Medicine, Queen's University Belfast Associate Medical Director (Research and Development), Belfast Health and Social Care Trust Wellcome Research Laboratories Top Floor, Institute of Clinical Science A Block, Royal Victoria Hospital Grosvenor Road Belfast BT12 6BJ Northern Ireland tel: 0044 2890 632743 fax: 0044 2890 235900 email: [log in to unmask] ----- Original Message ----- From: Hallworth Mike (RLZ) To: [log in to unmask] Sent: Monday, October 01, 2007 5:15 PM Subject: Profound hypomagnesaemia Does anyone have any ideas about a 62 year old chap who was found to be profoundly hypomagnesaemic (Mg<0.2 mmol/L) and hypocalcaemic with low PTH after a CABG in May, and has kept dropping his magnesium since then? He was also admitted in 2002 with a hypomagnesaemic/hypocalcaemic generalized seizure, following a diarrhoeal illness. There is no evidence of excessive renal Mg loss (urine Mg 0.4 mmol/L when serum Mg 0.22 and <0.2 mmol/L when serum 0.3), and the usual suspects (alcohol, drugs, poor diet) have been excluded. For many years, he has opened his bowel x3 daily, often with loose stool, and the gastroenterologists are looking at that, so it may just turn out to be secondary to abnormal GI loss, but I have been asked about the possibility of intestinal malabsorption due to mutation of the TRPM6 gene, as seen in familial hypomagnesaemia with secondary hypocalcaemia (he said, having just looked it up!!). Does anyone have any experience of this in adults as opposed to infants, or have any other bright ideas? He is currently being maintained on high dose oral magnesium which isn't really keeping up (Mg running around 0.5 mmol/L), and obviously isn't doing much for his loose bowel. Thanks Mike ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. 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