What is not a correct statement about Hypomagnesemia: Hypomagnesemia can cause neuromuscular, neurologic or cardiac manifestations, Proton pump inhibitors (PPIs) are associated with renal magnesium wasting, or Diarrhea is a common cause of Hypomagnesemia?

From the Guidelines

The incorrect statement about hypomagnesemia is that proton pump inhibitors are associated with renal magnesium wasting. Proton pump inhibitors (PPIs) actually cause hypomagnesemia through intestinal magnesium losses, not through renal wasting, as they reduce intestinal magnesium absorption by interfering with TRPM6 and TRPM7 channels in the intestine that are responsible for magnesium uptake 1. The other statements are correct:

• Hypomagnesemia can indeed cause neuromuscular, neurologic, or cardiac manifestations including tetany, seizures, arrhythmias, and muscle weakness.
• Diarrhea is also a common cause of hypomagnesemia due to gastrointestinal losses of magnesium, as stated in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Hypomagnesemia is clinically significant as magnesium is essential for numerous enzymatic reactions and proper functioning of the nervous and cardiovascular systems. Additionally, the risk of hypomagnesemia can be increased in certain clinical settings, such as in patients with acute or chronic kidney disease, where it can be caused by various factors including diarrhea, malabsorption syndrome, chronic use of proton pump inhibitors and diuretics, hypercalcemia, and volume expansion 1. Therefore, it is crucial to be aware of the correct causes of hypomagnesemia to provide appropriate management and prevent potential complications.

From the FDA Drug Label

Hypomagnesemia, symptomatic and asymptomatic, has been reported rarely in patients treated with PPIs for at least three months, in most cases after a year of therapy. Serious adverse events include tetany, arrhythmias, and seizures. In most patients, treatment of hypomagnesemia required magnesium replacement and discontinuation of the PPI For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.3)]. Low magnesium levels in your body. This problem can be serious Low magnesium can happen in some people who take a PPI medicine for at least 3 months. If low magnesium levels happen, it is usually after a year of treatment. You may or may not have symptoms of low magnesium Tell your doctor right away if you develop any of these symptoms: seizures jitteriness spasms of the hands and feet dizziness jerking movements or shaking (tremors) cramps or muscle aches abnormal or fast heart beat muscle weakness spasm of the voice box

The correct answer is: None of the Above

• Hypomagnesemia can cause neuromuscular, neurologic or cardiac manifestations: This statement is correct, as hypomagnesemia can lead to symptoms such as seizures, arrhythmias, and muscle weakness.
• Proton pump inhibitors are associated with renal magnesium wasting: This statement is correct, as PPIs can cause hypomagnesemia, which can be due to renal magnesium wasting.
• Diarrhea is a common cause of hypomagnesemia: Although the provided text does not directly mention diarrhea as a cause of hypomagnesemia, it is a known cause of hypomagnesemia in general. However, based on the provided text, we cannot conclude that any of the given options are incorrect. Therefore, the correct answer is None of the Above 2 2

From the Research

Hypomagnesemia Causes and Associations

• Hypomagnesemia can cause neuromuscular, neurologic, or cardiac manifestations 3, 4
• Proton pump inhibitors are associated with renal magnesium wasting, which can lead to hypomagnesemia 3, 4, 5, 6, 7
• Diarrhea is a common cause of hypomagnesemia, although the provided studies do not directly discuss this topic, other sources may support this claim

Proton Pump Inhibitors and Hypomagnesemia

• The use of proton pump inhibitors (PPIs) may increase the risk of hypomagnesemia 5
• Different PPIs have varying rates of hypomagnesemia, with pantoprazole having the highest rate and esomeprazole having the lowest rate 3
• The risk of PPI-associated hypomagnesemia is higher in males and the elderly population 3

None of the Above Option

• Based on the provided information, all the given options (Hypomagnesemia can cause neuromuscular, neurologic or cardiac manifestations, Proton pump inhibitors are associated with renal magnesium wasting, Diarrhea is a common cause of hypomagnesmia) are correct statements about hypomagnesemia, therefore the correct answer would be "None of the Above" as all the other options are correct statements.