This case presents an unusual presentation of severe hypocalcemia, hypomagnesemia, and hypokalemia that suddenly developed in a patient with a prior 15-year history of proton pump inhibitor (PPI) use with no prior complications. The patient developed acute onset of persistent tingling and numbness in her fingertips followed by acute confusion and perioral tingling. Upon hospitalization, she was found to have severe hypocalcemia, hypomagnesemia, and hypokalemia and required IV electrolyte repletion. This episode recurred, prompting the discontinuation of her PPI therapy. This unusual timing prompted an extensive workup to exclude alternative etiologies of hypocalcemia. Ultimately, PPI-induced hypomagnesemia was identified as the primary driver of the patient's electrolyte abnormalities. This case serves dual teaching points. First, it underscores the importance of recognizing that refractory hypocalcemia and hypokalemia can often be linked to untreated hypomagnesemia so that timely diagnosis, effective management, and minimization of hospitalizations can be ensured. Second, this case highlights the unusual timing of symptomatic hypomagnesemia and subsequent hypocalcemia and hypokalemia despite years of prior PPI usage without prior known complications.

Keywords: electrolyte disturbances; hypocalcemia; hypokalemia; hypomagnesemia; proton pump inhibitor.

© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society.

这个病例呈现了一种罕见的严重低钙血症、低镁血症和低钾血症的情况，这些症状在一个之前有15年质子泵抑制剂（PPI）使用史且没有并发症的患者中突然出现。患者首先出现了指尖持续性的刺痛和麻木感，随后发展为急性意识模糊及口周部位的刺痛感。住院后发现她患有严重的低钙血症、低镁血症和低钾血症，并需要静脉补充电解质治疗。该症状反复发作，导致停用了她的PPI疗法。这种不寻常的时间点促使进行广泛的检查以排除其他可能引起低钙血症的原因。最终确定，PPI引起的低镁血症是患者电解质异常的主要原因。此案例有两个教学要点。首先，它强调了认识到难治性低钙血症和低钾血症通常与未治疗的低镁血症相关的重要性，以便及时诊断、有效管理和减少住院次数。其次，这个病例突出了即使有多年PPI使用史且没有已知并发症的情况下，低镁血症及其随后出现的低钙血症和低钾血症症状发作的时间点可能是不寻常的。

关键词： 电解质紊乱；低钙血症；低钾血症；低镁血症；质子泵抑制剂。