From the Guidelines
Hypomagnesemia from gastrointestinal (GIT) causes is primarily due to decreased intestinal absorption, which can be caused by various factors including chronic diarrhea, malabsorption syndromes, and certain medications such as proton pump inhibitors. The most recent and highest quality study 1 suggests that proton pump inhibitor therapy can cause unwanted side effects, including magnesium deficiency, and recommends switching to alternative treatments if side effects occur. Other causes of hypomagnesemia include:
- Malabsorption syndromes like celiac disease, inflammatory bowel diseases (Crohn's disease and ulcerative colitis), and short bowel syndrome following extensive intestinal resection
- Certain medications, such as antibiotics (gentamicin, tobramycin), chemotherapeutic agents (cisplatin, carboplatin), and immunosuppressants (cyclosporine)
- Excessive alcohol consumption, which damages the intestinal epithelium and impairs magnesium absorption while increasing urinary excretion
- Chronic laxative abuse, which leads to accelerated intestinal transit time, reducing absorption opportunity
- Pancreatic insufficiency, which decreases magnesium absorption due to impaired fat digestion and steatorrhea
- Bariatric surgery procedures, especially those bypassing the duodenum and jejunum where magnesium is primarily absorbed, can cause long-term deficiency. According to a study published in 2021 1, hypomagnesemia has been reported in up to 12% of hospitalized patients, with an incidence around 60-65% among critically ill patients, and can be caused by increased magnesium removal during kidney replacement therapy. Another study published in 2006 1 recommends rehydration to correct secondary hyperaldosteronism, and oral magnesium supplements, such as magnesium oxide, to treat hypomagnesemia in patients with short bowel syndrome. It is essential to monitor magnesium levels in patients with these conditions, as deficiency can lead to neuromuscular symptoms, cardiac arrhythmias, and metabolic disturbances. In terms of prevention and treatment, a study published in 2006 1 recommends correcting water and sodium depletion, oral magnesium preparations, reducing excess lipid in the diet, and oral 1 alpha cholecalciferol. Overall, hypomagnesemia from GIT causes is a complex condition that requires careful management and monitoring to prevent long-term complications.
From the Research
Causes of Hypomagnesemia by Gastrointestinal Tract (GIT)
- The use of proton pump inhibitors (PPIs) has been linked to hypomagnesemia, a condition characterized by low serum magnesium levels 2, 3, 4, 5, 6.
- PPIs can affect the gastrointestinal absorption of magnesium, leading to hypomagnesemia 3, 4.
- The exact mechanism by which PPIs cause impaired magnesium absorption is still unknown, but it is thought to involve reduced magnesium solubility in the intestinal lumen and changes in the expression and activity of key transporter proteins 2.
- The gut microbiome may also contribute to the development of PPI-induced hypomagnesemia, as PPI use can alter the composition of the gut microbiome 2, 5.
- Low dietary magnesium intake and low gut microbiota diversity have been associated with an increased risk of developing PPI-induced hypomagnesemia 5.
- A meta-analysis of observational studies found that PPI use was significantly associated with hypomagnesemia, with a pooled unadjusted odds ratio of 1.83 and a pooled adjusted odds ratio of 1.71 6.
Potential Mechanisms
- Reduced magnesium solubility in the intestinal lumen 2
- Changes in the expression and activity of key transporter proteins 2
- Alterations in the gut microbiome 2, 5
- Low dietary magnesium intake 5
- Low gut microbiota diversity 5