• Wanxia Zhao, Jing Zhang, Hongwei Jia, Qing He, Jingqiu Cui, Li Ding, and Ming Liu.
• Department of Endocrinology, Tianjin Medical University General Hospital Airport Site, Tianjin, China.
• Medicine (Baltimore). 2024 Oct 4; 103 (40): e39729e39729.

RationaleHypomagnesemia is associated with multiple electrolyte disturbances such as hypokalemia, hypocalcemia and hypoparathyroidism. Proton pump inhibitors (PPIs) are widely used in gastrointestinal disorders and are generally considered safe by clinicians. However, it is unusual side effect of hypomagnesemia is potentially under-recognized. Delirium is usually thought to be a clue of cerebrovascular disease, and the association between delirium and hypomagnesemia is unexpected. We describe a patient used PPI with hypomagnesemia showed normal parathyroid hormone (PTH) despite hypocalcemia and reversible delirium. To enhance clinicians' vigilance, we performed a literature review on cerebellar syndromes due to hypomagnesemia.Patient ConcernsA 74-year-old woman was admitted to our hospital with intermittent nausea, vomiting, hand tremors, and delirium.DiagnosisLaboratory analysis showed hypokalemia, hypomagnesemia, and normal parathyroid hormone despite hypocalcemia, physical examination showed horizontal nystagmus and the brain MRI was negative. Surprising, detailed medical history revealed that the etiology was the usage of omeprazole.InterventionsOmeprazole was discontinued and oral supplementation with magnesium, calcium, and potassium was administered.OutcomesDelirium quickly disappeared and the serum potassium, magnesium, and calcium levels gradually normalized; at discharge, nystagmus gradually disappeared, and plasma electrolyte levels were stable at follow-up.LessonsHypomagnesemia is associated with a variety of neurological symptoms up to life-threatening conditions if left untreated; as Mg is not present in routine electrolyte panels, hypoparathyroidism, hypokalemia, and delirium may be a clue, and physicians must be alert to consider PPI as a potential cause of unexplained hypomagnesemia, and timely treatment to avoid sequelae.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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