Serum Magnesium in Proton Pump Inhibitors Users and Non-Users

Abstract Proton pump inhibitors (PPIs) are widely prescribed for acid-related gastrointestinal disorders and are generally considered safe. However, prolonged PPI use has been associated with electrolyte imbalances, particularly hypomagnesemia, which can result in severe complications such as arrhythmias, seizures, and tetany. Despite growing global concern, evidence on this association remains limited and inconclusive in Indian hospital populations, where PPI prescription rates are notably high. This study evaluated the relationship between prior PPI use and serum magnesium levels among hospitalized patients. A prospective case–control study was conducted on 370 inpatients (185 PPI users and 185 non-users) admitted to the Department of General Medicine at a tertiary care centre. Patients who had received PPI therapy for at least six months were included as cases, while those without prior PPI exposure served as controls. Serum magnesium levels were estimated using the modified methylthymol blue method, and demographic and clinical data were analyzed using SPSS version 24. The mean serum magnesium concentration was significantly lower in PPI users compared to controls (1.77 ± 0.48 mg/dL vs. 2.02 ± 0.43 mg/dL; p < 0.001). Hypomagnesemia (< 1.8 mg/dL) was observed in 54.6% of PPI users versus 25.9% of controls. Logistic regression analysis indicated that PPI use was independently associated with hypomagnesemia (odds ratio = 2.475; 95% CI: 1.605–3.816). These findings suggest that long-term PPI therapy is significantly associated with reduced serum magnesium levels. Therefore, regular monitoring of serum magnesium is recommended in chronic PPI users to prevent potential adverse clinical outcomes.