Hypomagnesemia in intestinal lymphangiectasia: a case report and review of the literature

Abstract

Background Intestinal lymphangiectasia (IL) is a rare disease characterized by dilation of lymphatic vessels and leakage of lymphatic fluids into the intestinal lumen, causing depletion of lymphocytes, protein, lipids, fat-soluble vitamins, and electrolytes. Hypomagnesemia can occur in IL patients but is seldom discussed. Case presentation A 30-year-old Tibetan woman who had chronic diarrhea, edema, tetany, and tingling was diagnosed with IL. Prominent hypomagnesemia was noticed. She was treated with a medium-chain triglyceride (MCT) diet and nutrient supplementation with satisfactory results. We also present a systematic review of hypomagnesemia in IL cases from the published literature. Conclusions Hypomagnesemia may be an overlooked complication of IL, thus monitoring serum magnesium concentrations in IL patients is crucial.

Hypocalcaemic tetany linked to vitamin D deficiency and hypomagnesemia in primary intestinal lymphangiectasia: a literature review

“…Hypoalbuminemia, lymphopenia, and hypogammaglobulinemia are observed as constant biological findings in cases of PIL 1 . The cause of hypoalbuminemia appeared to be lymphatic leakage and diarrhoea, in absence of liver synthesis dysfunction or renal protein leakage in the patient 21 . Low oncotic pressure due to hypoalbuminemia often leads to peripheral pitting oedema 8 .…”

“…When vitamin D deficiency persists for a prolonged duration, it results in osteomalacia or rickets, while less severe deficiency, accompanied by secondary hyperparathyroidism, leads to osteopenia 24 . Moreover, severe vitamin D deficiency impairs calcium and phosphate absorption from the small intestine 25 leading to hypocalcemia and ultimately to recurrent episodes of tetany 21 . Tetany is unlikely to occur unless the ionized calcium concentration drops below 4.3 mg/dl (1.1 mmol/l), which typically corresponds to a serum calcium concentration of 7.0–7.5 mg/dl (1.8–1.9 mmol/l) 23 .…”

“…In PIL, hypomagnesemia may result from insufficient magnesium absorption, secondary to persistent diarrhoea 21 . As one-third of serum magnesium binds to albumin, hypoalbuminemia could further disturb magnesium transport and equilibrium, exacerbating the hypomagnesemia 27 .…”

“…Hypomagnesemia in IL can lead to various clinical consequences. Severe reductions in serum magnesium may result in arrhythmias, such as prolonged PR intervals, widening QRS complexes, and notably, torsades de pointes 21 . Additionally, it can induce neuromuscular hyperactivity, contributing to tetany and seizures 21 , 28 .…”

Spectrum of Disorders associated with Tetany

“…53 Tetany from hypomagnesemia due to intestinal lymphangiectasia has also been reported. 54 Hypomagnesemia c aus es hy p o c alcemia by p erip h eral parathyroid hormone resistance. Impairment of parathyroid hormone secretion is also seen at very low serum magnesium levels (<1 mg/dL).…”