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[Hypomagnesemia due to PPI]

±×°ÍÀÌ ¾Ë°í½Í´Ù, ¼ÒÈ­±â ³»°ú Áø·áÇöÀå¿¡¼­ ³ª¿Â ¾à¸®Çп¡ °üÇÑ Áú¹®µé (°¡Å縯´ëÇб³ ¾à¸®Çб³½Ç ÀÓµ¿¼®)


"Lemonade Legs"¶ó´Â ¸»À» µé¾îº¸¼Ì½À´Ï±î? Intestinal Research 2015³â 3È£¿¡ ½Ç¸° Á¾¼³ÀÇ Á¦¸ñÀÔ´Ï´Ù (Atkinson. Intest Res. 2015). PPI »ç¿ëÀÚ¿¡¼­ °£È¤ ¹ß»ýÇÏ´Â hypomagnesemia¿¡ ÀÇÇÑ ±Ù°ñ°Ý°è Áõ»óÀ» Ç¥ÇöÇÏ´Â ¿ë¾î¶ó°í ÇÕ´Ï´Ù. Weakness, fatigue, muscle cramps and spasms, tetany µîÀÌ °¡´ÉÇÕ´Ï´Ù. ½Å°æÁõ»ó, ¼ÒÈ­±âÁõ»ó, ºÎÁ¤¸Æ, COPDÀÇ ¾ÇÈ­ µîµµ PPI¿¡ ÀÇÇÑ hypomagnasemia¿Í °ü·ÃµÉ ¼ö ÀÖ½À´Ï´Ù.

Proton pump inhibitors (PPIs) are widely used though an association with hypomagnesaemia and hypocalcaemia has only been described since 2006. Patients typically present after years of stable dosing with musculoskeletal, neurological or cardiac arrhythmic symptoms, but it is likely that many cases are under-recognised. Magnesium levels resolve rapidly on discontinuation of PPI therapy and hypomagnesaemia recurs rapidly on rechallenge with any agent in the class.

The cellular mechanisms of magnesium homeostasis are increasingly being understood, including both passive paracellular absorption through claudins and active transcellular transporters, including the transient receptor potential channels (TRPM6) identified in the intestine and nephron. PPIs may alter luminal pH by modulating pancreatic secretions, affecting non-gastric H+K+ATPase secretion, altering transporter transcription or channel function. A small reduction in intestinal absorption appears pivotal in causing cumulative deficiency. Risk factors have been associated to help identify patients at risk of this effect but clinical vigilance remains necessary for diagnosis.

Hypomagnasemia´Â PPI Àå±â»ç¿ëÀÚ¿¡¼­ ¹ß»ýÇÏ´Â °æ¿ì°¡ ¸¹Áö¸¸, °£È¤ PPI »ç¿ë 2ÁÖ ÈÄ¿¡µµ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. Class effectµµ ÀÖ½À´Ï´Ù. ÇÑ PPI¿¡ ÀÇÇÏ¿© hypomagnesemia°¡ ¹ß»ýÇÏ¸é ´Ù¸¥ PPI·Î ¹Ù²ãµµ ¹ß»ýÇÑ´Ù´Â °ÍÀÔ´Ï´Ù. Áõ»óÀº ¸Å¿ì ´Ù¾çÇÕ´Ï´Ù. ºÎÁ¤¸Æµµ °¡´ÉÇÕ´Ï´Ù. Hypomagnesemia¸¦ ÀǽÉÇÏÁö ¸øÇÑ »óÅ¿¡¼­ °©Àڱ⠵¹¾Æ°¡½Ã´Â ºÐµµ ¾øÁö ¾ÊÀ» °Í °°½À´Ï´Ù.

¾ÆÁ÷ PPI »ç¿ëÀÚÀÇ magnesium ÃøÁ¤ ÁöħÀº ¾ø½À´Ï´Ù. Á¶±ÝÀÌ¶óµµ ÀÇ½ÉµÇ¸é °Ë»çÇغ¸´Â ¼ö ¹Û¿¡ ¾øÀ» °Í °°½À´Ï´Ù. ÀÀ±Þ½Ç¿¡¼­´Â ´õ¿í Áß¿äÇÕ´Ï´Ù. Áõ»óÀÌ ¾ø´õ¶óµµ PPI Àå±â »ç¿ëÀÚ¿Í ÀÌ´¢Á¦ »ç¿ëÀÚ¿¡¼­ °í·ÁÇØ º¼ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. ´ÙÇེ·´°Ô ¾ÆÁÖ ÈçÇÑ ÀÏÀº ¾Æ´Ï¶ó°í ÇÕ´Ï´Ù.

Histamine 2 receptor antagonistµµ hypomagensemia¸¦ ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù (Kieboom BC. Am J Kidney Dis. 2015). ±×·¯³ª ±× Á¤µµ´Â PPIº¸´Ù ´ú ½ÉÇÑ ¸ð¾çÀÔ´Ï´Ù.


[References]

1) The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis. - 2014³â ¸ÞŸºÐ¼® (¿¬¼¼´ëÇб³ ÀÌ»ó±æ ±³¼ö´Ô ÆÀ)

2) Relative potency of PPIs

Interchangeable use of PPIs based on relative potency (Clin Gastroenterol Hepatol 2018)
Drug at lowest available dosageOmeprazole equivalent
Pantoprazole 20 mg4.5 mg
Lansoprazole 15 mg13.5 mg
Omeprazole 20 mg20 mg
Esomeprazole 20 mg32 mg
Rabeprazole 20 mg36 mg


© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng