Magnesium levels are maintained by equilibrium of both gastrointestinal absorption and renal tubular excretion. PPI use is a problem in practice and needs to be addressed, as long-term use is associated with hypomagnesemic hypoparathyroidism leading to secondary hypocalcemia. Therefore, continual monitoring and decision making on whether to reduce the dose/withdraw the PPI is essential to avoid complications.
Hypomagnesaemia is often undiagnosed and is associated with multiple biochemical abnormalities. In summary, the management of PPI-induced symptomatic hypomagnesemia is to withdraw the PPI and initial correction with an intravenous magnesium infusion, in turn correcting both the calcium and potassium levels. It is acceptable to stop supplementation once magnesium levels are restored