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PRACTICE: N Shabajee, E J Lamb, I Sturgess, and R W Sumathipala Omeprazole and refractory hypomagnesaemia BMJ 2008; 337: a425 [Full text]

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Type 2 diabetes, omeprazole and hypomagnesaemia

Francisco José Fernández-Fernández, Beatriz Buño-Ramilo, Elena Solla-Babío, Tamara Caínzos-Romero   (29 July 2008)

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Robert J Pierce   (12 September 2008)

Type 2 diabetes, omeprazole and hypomagnesaemia 29 July 2008
Francisco José Fernández-Fernández, Service of Internal Medicine Hospital Arquitecto Marcide. Ferrol. Spain, Beatriz Buño-Ramilo, Elena Solla-Babío, Tamara Caínzos-Romero Send response to journal: Re: Type 2 diabetes, omeprazole and hypomagnesaemia	In their interesting case report (1), Shabajee et al. showed that omeprazole caused hypomagnesaemia in two patients. In our clinical practice, the plasma magnesium concentration is often not measured as part of the routine screening blood tests. The case 2 of their article had diabetes, and hypomagnesaemia has been reported to occur in 13.5 to 47.7 % of outpatients with type 2 diabetes compared with 2.5 to 15 % among their counterparts without diabetes (2). Hypomagnesaemia in patients with diabetes mellitus may result from poor oral intake, malabsorption, and increased urinary excretion. Aspirin is frequently used in diabetic patients and omeprazole may be necessary for prophylaxis of gastroduodenal mucosal injury. Therefore, the risk of hypomagnesaemia may be higher in diabetic patients treated with omeprazole. Perhaps, it might be prudent to monitor serum magnesium concentration in patients with diabetes mellitus taking proton pump inhibitors. References 1.Shabajee N, Lamb EJ, Sturgess I, Sumathipala RW. Omeprazole and refractory hypomagnesaemia. BMJ 2008;337:173-5. 2.Pham PC, Pham PM, Pham SV, Miller JM, Pham PT. Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol 2007;2:366-73. Competing interests: None declared
it really works! 12 September 2008
Robert J Pierce, GP Lambeth St Surgery, Blackburn, BB1 1LZ Send response to journal: Re: it really works!	I have a patient who has been an inpatient a couple of times in the last few months with severe hypomagnesaemia of unknown cause (it had been put down to excessive alcohol intake, but he stopped drinking months ago). He was treated with a magnesium infusion on each occasion and discharged. He's not diabetic but was on omeprazole for treatment of Barrett's oesophagus. He returned to see me last week feeling generally unwell again, and his bloods showed a magnesium of <0.08 (0.70-0.90), corrected calcium of 1.93 and potassium of 3.3. Having read the case studies I stopped the omeprazole, and repeating his bloods yesterday they have all come back normal today (magnesium 0.82). Fantastic! Editorial note The patient whose case is described has given his signed informed consent to publication. Competing interests: None declared