SHM Converge Scientific Abstract ePoster Gallery-A Heartbreaking Story of Hypomagnesemia

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This case describes a 69-year-old woman with celiac disease and chronic magnesium supplementation who presented with progressive weakness, nausea/vomiting, poor intake, confusion, and severe functional decline. On exam she was dehydrated, diffusely tender in the abdomen, and had Chvostek’s sign, suggesting neuromuscular irritability from profound electrolyte disturbance. Initial labs showed crisis-level abnormalities: magnesium 0.5, calcium 6.6 with low ionized calcium, potassium 2.3, and phosphorus 1.9, along with elevated lactate and mild troponin elevation.<br /><br />Her history suggested chronic malabsorption worsened by recent gastrointestinal losses. Her PCP had stopped magnesium supplementation 2.5 months earlier because of loose stools, and she was also taking a PPI, which can contribute to hypomagnesemia. During hospitalization she received IV magnesium and replacement of calcium, potassium, and phosphorus; the PPI was discontinued. Cardiology was consulted because of troponin elevation and coronary calcifications, but stress testing showed no inducible ischemia, and the troponin rise was attributed to physiologic stress/electrolyte derangement rather than acute coronary syndrome. Nephrology felt she had chronic hypomagnesemia with secondary hypokalemia, acutely worsened by GI losses.<br /><br />Her course was complicated by significant delirium requiring a sitter and antipsychotics. Hypomagnesemia recurred intermittently with milder psychiatric symptoms, but her mental status gradually improved and delirium resolved by hospital day 10; she was discharged on day 13.<br /><br />The presentation highlights the broad manifestations of hypomagnesemia, which can range from tremor, weakness, and Chvostek’s sign to delirium, tetany, arrhythmias, vasospasm, ischemia, and even coma. Key contributors to magnesium loss include GI losses, malabsorptive states such as celiac disease, and PPIs. Management principles emphasized ongoing repletion, addressing the underlying cause, and considering magnesium-sparing strategies such as amiloride or SGLT2 inhibitors if PPI therapy must be continued.

Asset Subtitle

Elena A. Einspahr

Meta Tag

Author List Elena A. Einspahr, Elizabeth Miles

Category Clinical Vignettes

Concept Hypomagnesemia

Concept Tetany

Concept Cardiac Arrhythmia

Concept Magnesium Loss

Concept Electrolyte Repletion

Distinguished Non-Finalist

Presenter Organization University of Nebraska Medical Center

Presenting Author Elena A. Einspahr

Track Adult

Keywords

hypomagnesemia

celiac disease

electrolyte imbalance

delirium

magnesium supplementation

proton pump inhibitor

hypocalcemia

hypokalemia

malabsorption

Chvostek sign

Hypomagnesemia

Tetany

Cardiac Arrhythmia

Magnesium Loss

Electrolyte Repletion