CASE REPORT article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1646741
This article is part of the Research TopicOptimizing Medication Management in Older Adults: Addressing Polypharmacy, Deprescribing and Represcribing ChallengesView all 7 articles
Multiple Electrolyte Disturbance with Severe Neurological Manifestations Induced by Chronic Use of PPIs
Provisionally accepted
Alexander Bertuccioli1,2
Marco Cardinali1,3
Francesco Di Pierro2,4,5
Giordano Bruno Zonzini1,2
Nicola Zerbinati6
Maria Laura Tanda5
Annalisa Belli1
Chiara Maria Palazzi2*- 1Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61122 Urbino, Italy, Urbino, Italy
- 2Microbiota International Clinical Society, Torino, Italy
- 3Department of Internal Medicine, Infermi Hospital, AUSL Romagna, 47921 Rimini, Italy, Rimini, Italy
- 4Scientific & Research Department, Velleja Research, 20125, Milan, Italy
- 5Department of Medicine and Surgery, University of Insubria, 21100, Varese, Italy
- 6Department of Medicine and Technological Innovation, University of Insubria 21100, Varese, Italy
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Background: proton pump inhibitors (PPIs) are widely prescribed, especially in older adults with multiple comorbidities. However, their long-term use may lead to under-recognized adverse effects, including hypomagnesemia and related electrolyte disturbances, with potential neuromuscular and cognitive consequences. Case Presentation: an 84-year-old man with several chronic conditions and prolonged PPI therapy presented with recurrent dysphagia, neuromuscular symptoms, and seizure-like episodes. Laboratory tests consistently showed hypokalemia and hypocalcemia, with intermittent hypomagnesemia, despite ongoing supplementation. Intervention: a comprehensive medication review led to the discontinuation of both pantoprazole and levetiracetam. The Naranjo algorithm was used to assess causality, indicating a probable adverse drug reaction. Outcome: following drug withdrawal, the patient experienced marked clinical improvement, with normalization of electrolyte levels. He no longer required supplementation and maintained stability through dietary management and adjustment of his antihypertensive therapy. Conclusion: this case highlights the dual iatrogenic role of PPIs and antiepileptics in causing persistent electrolyte imbalances. It emphasizes the need for regular medication reviews in elderly, polymedicated patients to prevent functional decline and promote recovery.
Keywords: hypomagnesemia1, proton pump inhibitors2, electrolyte3, polypharmacy4, geriatricassessment5
Received: 13 Jun 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Bertuccioli, Cardinali, Di Pierro, Zonzini, Zerbinati, Tanda, Belli and Palazzi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chiara Maria Palazzi, Microbiota International Clinical Society, Torino, Italy
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