Which electrolyte disturbance is associated with long-term use of proton pump inhibitors such as lansoprazole?

• A. Hypermagnesemia
• B. Hypomagnesemia
• C. Hypokalemia
• D. Hypercalcemia

Answer: (B)

Long-term suppression of stomach acid with proton pump inhibitors can reduce magnesium absorption in the gut. Magnesium is absorbed mainly in the small intestine, and the low acidity from prolonged PPI use impairs this process, leading to low magnesium levels over time. This hypomagnesemia can present with symptoms like muscle cramps, tremors, arrhythmias, or seizures and can also trigger secondary electrolyte changes such as low potassium or calcium. While not every patient on a PPI will develop low magnesium, it’s a well-recognized association, especially with long-term therapy or in those taking diuretics or with kidney issues. If someone on a long-term PPI shows fatigue, weakness, cramps, or arrhythmias, checking magnesium and addressing it is important, which may involve supplementation and re-evaluating the need for ongoing PPI therapy. Hypermagnesemia is not the typical disturbance linked to PPI use, and although hypokalemia or hypocalcemia can occur in certain scenarios, the characteristic electrolyte disturbance with long-term PPI use is low magnesium.