Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol

Abstract

SUMMARYIn February 2011, the Food and Drug Administration informed that prescription of proton pump inhibitor (PPI) drugs may cause low serum magnesium levels if taken for prolonged periods of time. We present an ex-smoker, 76-year-old man, with high blood pressure, diabetes mellitus and Barrett's oesophagus (treated with esomeprazole since 2003) admitted due to fluctuating aphasia. Neurovascular and neuroimaging studies were normal. Dyslipidemia and atrial arrhythmia were discovered. The patient was discharged with the diagnosis of left middle cerebral artery transient ischaemic attack and anticoagulation treatment was recommended. The patient returned to the emergency department on further two occasions (confusional episodes) and was admitted in order to complete the neurological study that was normal. The patient was discharged with the diagnosis of probable epileptic seizures. After a week, he was admitted due to generalised temblor and unsteadiness. A complete blood test was performed and showed a severe hypomagnesaemia (not previously performed). BACKGROUND

Dementia, cognitive impairment and proton pump inhibitor therapy: A systematic review

“…The systematic search strategy identified 1928 unique articles, 1895 of which were excluded during title and abstract screening. Thirty‐three remaining full text articles were assessed for eligibility, and of these, 11 met the inclusion criteria for this systematic review . Reasons for study exclusion are documented using the PRISMA flow diagram (Fig.…”

“…Of six total cases included in this systematic review, three were case reports and three were presented as case series . Four were cases of hypomagnesemia‐associated delirium or confusion, one was a case of hyponatremic delirium, and one was a case of delirium of unknown cause . One case demonstrated that withdrawal of trial esomeprazole therapy resulted in the resolution of symptoms and restoration of magnesium levels .…”

“…Four were cases of hypomagnesemia‐associated delirium or confusion, one was a case of hyponatremic delirium, and one was a case of delirium of unknown cause . One case demonstrated that withdrawal of trial esomeprazole therapy resulted in the resolution of symptoms and restoration of magnesium levels . The significance of PPI therapy in causing low levels of magnesium or sodium was judged as probable in the majority of cases, and was most frequently observed in patients using omeprazole …”

“…PPIs have also been identified as a potential factor in the development of vitamin B12 deficiency, a factor that may also contribute towards the development of dementia . The findings of case studies and small observational studies have suggested a link between PPI use and acute cognitive impairment …”

Prescription of Proton Pump Inhibitors in Elderly Subjects in Real Life: A Retrospective Study in a Gastroenterology Department

“…• The consequences of the malabsorption: hyponatremia [17,18], deficiency in vitamin B12 [19] and hypomagnesemia [20,21] (which could have serious consequences such as confusion [22,23])…”