Question

jj is a 67 yo male with htn, diabetes, hyperlipidemia, and chf. jj presents today one day after a routine follow-up and yearly lab draw (results below) with his primary care provider. due to worsening lower extremity edema, jj’s furosemide was increased from 20 mg daily to 20 mg twice daily four weeks ago. today, edema is much improved and his doctor has recommended he maintain this increased dose of furosemide. jj has no other complaints at this time and all other disease states are stable. current medications: lisinopril 40 mg daily, metoprolol tartrate 200 mg daily; furosemide 20 mg twice daily (increased four weeks ago from 20 mg daily); atorvastatin 40 mg daily; lantus 30 units at bedtime; humalog kwik-pen, 12 units before breakfast and lunch, 15 units before dinner, esomeprazole 40 mg qam. vitals: blood pressure 125/70 mmhg; pulse 65 bpm, weight 80 kg labs (from yesterday’s primary care provider visit): na+ 138 meq/l, k+ 2.9 meq/l, cl- 100 meq/l, creatinine 1.3 mg/dl, mg++ 1.2 meq/l (1.44 mg/dl). all other values are within normal limits. most recent echo (6 months ago): ejection fraction 55% what medication/s in the patient’s current regimen could contribute to hypomagnesemia? select one:

a. atorvastatin

b. lisinopril

c. esomeprazole

d. all the choices are correct

Answer 1

Proton pump inhibitors are very well known to cause hypomagnesemia.Proton pump inhibitors cause the impaired absorption of magnesium via TRPM6/7.Due to this magnesium isn't absorbed from the intestine and this leads to hypomagnesemia.

In the above regimen Esomeprazole is a proton pump inhibitor and it causes hypomagnesemia.

So the correct answer should be option C.