Severe Hypomagnesemia Induced by Postoperative Zinc Supplementation: An Illustrative Demonstration of Electrolyte Homeostasis.

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2025-03-10 eCollection Date: 2025-01-01 DOI:10.12890/2025_005247
Max Slosarski, Christ Ordookhanian, Ryan F Amidon, Edward Lee, Tedrik Markarian, Paul Kaloostian
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引用次数: 0

Abstract

Background: Managing electrolyte abnormalities is one of the cornerstones of properly caring for and managing hospitalized patients. Typically, electrolyte derangements are managed by direct repletion, volume status correction, or hemodialysis; however, the persistence of electrolyte abnormalities despite utilizing appropriate initial strategies requires further investigation.

Case description: A 72-year-old male presented to the emergency department with weakness 2 months post-exploratory laparotomy with ileostomy for small bowel perforation complicated by intra-abdominal infection. The patient was treated for sepsis and imaging revealed intra-abdominal and abdominal wall abscesses. After drainage, recovery was complicated by treatment of refractory hypomagnesemia in the context of zinc supplementation.

Discussion: If initial electrolyte repletion measures do not provide the intended benefit, investigating secondary causes of refractory electrolyte abnormalities is necessary. While hypomagnesemia is one of the least common electrolyte derangements seen within the general acute care hospital setting, in facilities with relatively high volumes of bariatric or gastrointestinal surgical patients, keeping the phenomenon of zinc-induced hypomagnesemia in mind becomes more crucial due to its frequent use in those settings.

Conclusion: This case highlights the effects of excess high-dose zinc supplementation in a patient without zinc deficiency in the postoperative period who developed treatment-resistant hypomagnesemia due to zinc-induced impairment of magnesium absorption as well as gastrointestinal and renal losses.

Learning points: Zinc supplementation can cause hypomagnesemia.

术后补锌引起的严重低镁血症:电解质稳态的说明性论证。
背景:控制电解质异常是正确护理和管理住院患者的基石之一。通常,电解质紊乱通过直接补充、容量状态校正或血液透析来处理;然而,尽管采用了适当的初始策略,但电解质异常的持续存在需要进一步的研究。病例描述:一名72岁男性,因小肠穿孔并发腹腔内感染,剖腹探查术后2个月虚弱而就诊于急诊科。患者接受脓毒症治疗,影像学显示腹内及腹壁脓肿。引流后,在补充锌的情况下治疗难治性低镁血症使恢复变得复杂。讨论:如果最初的电解质补充措施不能提供预期的好处,调查难治性电解质异常的次要原因是必要的。虽然低镁血症是普通急症医院环境中最不常见的电解质紊乱之一,但在具有相对大量肥胖或胃肠道手术患者的设施中,由于锌引起的低镁血症在这些环境中频繁使用,因此牢记锌引起的低镁血症现象变得更加重要。结论:该病例强调了过量高剂量补锌对术后无缺锌患者的影响,该患者由于锌引起的镁吸收障碍以及胃肠道和肾脏损失而发生治疗抵抗性低镁血症。学习要点:补锌会导致低镁血症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
期刊介绍: The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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