Uses of proton pump inhibitors and hypomagnesemia

Purpose: Hypomagnesemia associated with proton pump inhibitor (PPI) therapy has been documented in case reports. We performed a cross-sectional study to examine the association between PPI use and serum magnesium (Mg) levels or hypomagnesemia. Methods: Data were extracted from hospitalized adults with basic metabolic panels and/or serum magnesium levels available during the hospital stays. The first Mg value was used for data analysis. Hypomagnesemia is defined as levels less than 1.7mg/dL (or 0.70mmol/L). Multiple linear and logistic regression analyses were used to assess the association between PPI use and Mg levels or hypomagnesemia, respectively. Results: Among study patients, PPI users (n=207) had a mean Mg level of 1.91[SD=0.34] mg/dL, and non-users (n=280) 2.00 (0.30) mg/dL, p=0.004. PPI use was associated with lower serum Mg levels (adjusted coefficient β=-0.10, 95%CI=[-0.16, -0.04]) after adjusting for confounders. PPI use was associated with risk of hypomagnesemia after adjusting for confounders (adjusted OR=2.50, 95%CI=[1.43, 4.36]). Both standard (1) and high (2 or higher) defined daily dose units of PPI therapy were associated with hypomagnesemia. Conclusions: PPI use was associated with lower serum Mg levels and hypomagnesemia in a population of hospitalized adult patients. Our study supports the general notion that long-term PPI use could be associated with sub-clinical Mg insufficiency or deficiency status.