Seizure-like Symptoms Induced by Hypomagnesemia in a Patient with Incomplete Small Bowel Obstruction; A Case Report
Hypomagnesemia Causes Seizure due to Bowel Obstruction
Keywords:
hypomagnesemia; seizure; intestinal obstruction; nutritional supportAbstract
Background: Seizure-like symptoms are rare in older patients without brain damage. Small bowel obstruction is a common clinical disorder for older patients that can cause electrolyte disturbances and nutritional disorders. Hypomagnesemia is a frequently overlooked electrolyte disorder. Moreover, magnesium deficiency can lead to severe seizure-like symptoms. Case Report: An 85-year-old man was admitted to the hospital with weakness and slow movement. Shortly after hospitalization, he experienced incomplete small bowel obstruction; thus, parenteral nutrition and intravenous esomeprazole were administered. When intestinal obstruction was relieved, the patient suddenly experienced seizure-like symptoms three times, and 24-h electroencephalogram did not capture any epileptiform pattern. After excluding other causes, we considered serum magnesium deficiency as a diagnosis. Low serum magnesium levels were related to a shortage of absorption due to small bowel obstruction, excess excretion of renal dysfunction, and the use of proton pump inhibitor. However, the exact mechanism underlying the hypomagnesemia-induced seizure-like activity remained unclear. After adjusting the nutritional support and magnesium supplementation, the patient’s serum magnesium level returned to normal, and he was free of seizure-like activity. Conclusion: Hypomagnesemia is often asymptomatic, but it can lead to severe seizure-like symptoms. It is important to pay attention to the serum magnesium level and nutritional intake in patients with an incomplete small bowel obstruction.
References
Ahmed F, Mohammed A. Magnesium: The Forgotten Electrolyte-A Review on Hypomagnesemia. Med Sci (Basel). 2019, 7(4):56.
https://doi.org/10.3390/medsci7040056
PMid:30987399 PMCid:PMC6524065
Al Alawi AM, Majoni SW, Falhammar H. Magnesium and Human Health: Perspectives and Research Directions. Int J Endocrinol. 2018; 2018:9041694.
https://doi.org/10.1155/2018/9041694
PMid:29849626 PMCid:PMC5926493
Jin F, Huang Y, Hattori M. Recent Advances in the Structural Biology of Mg(2+) Channels and Transporters. J Mol Biol. 2022; 434(19):167729.
https://doi.org/10.1016/j.jmb.2022.167729
PMid:35841930
de Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiol Rev. 2015; 95(1):1-46.
https://doi.org/10.1152/physrev.00012.2014
PMid:25540137
Konrad M, Schlingmann KP, Gudermann T. Insights into the molecular nature of magnesium homeostasis. Am J Physiol Renal Physiol. 2004; 286(4):F599-605.
https://doi.org/10.1152/ajprenal.00312.2003
PMid:15001450
Al-Omairi A, Alfarsi A. Hypomagnesemia-Induced Seizures Post Severe Acute Kidney Injury. Cureus. 2022; 14(6):e26142.
https://doi.org/10.7759/cureus.26142
PMid:35891828 PMCid:PMC9301612
Barker-Haliski M, White HS. Glutamatergic Mechanisms Associated with Seizures and Epilepsy. Cold Spring Harb Perspect Med. 2015; 5(8):a022863.
https://doi.org/10.1101/cshperspect.a022863
PMid:26101204 PMCid:PMC4526718
Chen BB, Prasad C, Kobrzynski M, Campbell C, Filler G. Seizures Related to Hypomagnesemia: A Case Series and Review of the Literature. Child Neurol Open. 2016; 3:2329048x16674834.
https://doi.org/10.1177/2329048X16674834
PMid:28503619 PMCid:PMC5417264
Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. Nutrients. 2018; 10(6):730.
https://doi.org/10.3390/nu10060730
PMid:29882776 PMCid:PMC6024559
Schwalfenberg GK, Genuis SJ. The Importance of Magnesium in Clinical Healthcare. Scientifica. 2017,;2017:4179326.
https://doi.org/10.1155/2017/4179326
PMid:29093983 PMCid:PMC5637834
Pelczyńska M, Moszak M, Bogdański P. The Role of Magnesium in the Pathogenesis of Metabolic Disorders. Nutrients. 2022; 14(9):1714.
https://doi.org/10.3390/nu14091714
PMid:35565682 PMCid:PMC9103223
Botturi A, Ciappolino V, Delvecchio G, Boscutti A, Viscardi B, Brambilla P. The Role and the Effect of Magnesium in Mental Disorders: A Systematic Review. Nutrients. 2020; 12(6):1661.
https://doi.org/10.3390/nu12061661
PMid:32503201 PMCid:PMC7352515
Wu J, Yang Z, Wei J, Zeng C, Wang Y, Yang T. Association Between Serum Magnesium and the Prevalence of Kidney Stones: a Cross-sectional Study. Biol Trace Elem Res. 2020; 195(1):20-26.
https://doi.org/10.1007/s12011-019-01830-3
PMid:31338801
Ashitomi Y, Konta T, Motoi F, Watanabe M, Kayama T, Ueno Y. Association between Serum Magnesium Levels and Mortality in a Community-Based Population: The Yamagata (Takahata) Study. J Nutr Sci Vitaminol. 2022; 68(4):270-275.
https://doi.org/10.3177/jnsv.68.270
PMid:36047098
Nardone R, Brigo F, Trinka E. Acute Symptomatic Seizures Caused by Electrolyte Disturbances. J Clin Neurol. 2016; 12(1):21-33.
https://doi.org/10.3988/jcn.2016.12.1.21
PMid:26754778 PMCid:PMC4712283
Michael G, George K. A Case of Hypomagnesemia Presenting as New-Onset Seizure. Cureus. 2022; 14(4):e23791.
https://doi.org/10.7759/cureus.23791
Dharnidharka VR, Carney PR. Isolated idiopathic hypomagnesemia presenting as aphasia and seizures. Pediatr Neurol. 2005; 33(1):61-65.
https://doi.org/10.1016/j.pediatrneurol.2005.02.005
PMid:15876516
Weisleder P, Tobin JA, Kerrigan JF, Bodensteiner JB. Hypomagnesemic seizures: case report and presumed pathophysiology. J Child Neurol. 2002; 17(1):59-61.
https://doi.org/10.1177/088307380201700117
PMid:11913575
Ismail AAA, Ismail Y, Ismail AA. Chronic magnesium deficiency and human disease; time for reappraisal? QJM. 2018; 111(11):759-763.
https://doi.org/10.1093/qjmed/hcx186
PMid:29036357
Zafar MS, Wani JI, Karim R, Mir MM, Koul PA. Significance of serum magnesium levels in critically ill-patients. Int J Appl Basic Med Res. 2014; 4(1):34-37.
https://doi.org/10.4103/2229-516X.125690
PMid:24600576 PMCid:PMC3931212
Sakaguchi Y. The emerging role of magnesium in CKD. Clin Exp Nephrol. 2022; 26(5):379-384.
https://doi.org/10.1007/s10157-022-02182-4
PMid:35076791 PMCid:PMC9012765
Zhu XP, Zhu LL, Zhou Q. Prescribing practice and evaluation of appropriateness of enteral nutrition in a university teaching hospital. Ther Clin Risk Manag. 2013; 9:37-43.
https://doi.org/10.2147/TCRM.S41022
PMid:23404197 PMCid:PMC3569378
Park CH, Kim EH, Roh YH, Kim HY, Lee SK. The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis. PLoS One. 2014; 9(11):e112558.
https://doi.org/10.1371/journal.pone.0112558
PMid:25394217 PMCid:PMC4230950
Aydın Yoldemir Ş, Zeren Ozturk G, Akarsu M, Ozcan M. Is there a correlation between hypomagnesemia linked to long-term proton pump inhibitor use and the active agent? Wien Klin Wochenschr. 2022; 134(3-4):104-109.
https://doi.org/10.1007/s00508-021-01834-x
PMid:33751184
Gommers LMM, Hoenderop JGJ, de Baaij JHF. Mechanisms of proton pump inhibitor-induced hypomagnesemia. Acta Physiol (Oxf). 2022; 235(4):e13846.
https://doi.org/10.1111/apha.13846
PMid:35652564 PMCid:PMC9539870
Luk CP, Parsons R, Lee YP, Hughes JD. Proton pump inhibitor-associated hypomagnesemia: what do FDA data tell us? Ann Pharmacother. 2013; 47(6):773-780.
https://doi.org/10.1345/aph.1R556
PMid:23632281
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