Severe Hypomagnesemia and Hypocalcemia Linked to Semaglutide in Type 2 Diabetes: A Case Report
Abstract
Patient: Female, 73-year-old Final Diagnosis: Severe hypomagnesemia Symptoms: Collapse Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Although hypomagnesemia is common in type 2 diabetes, clinical presentations with severe hypomagnesemia are rare. A number of oral blood glucose-lowering medications can reduce serum magnesium concentrations, and several severe cases have been reported in the presence of marked glucagon-like peptide-1 receptor agonist (GLP-1RA)-associated gastrointestinal adverse effects. In the present case, an acute presentation with severe hypomagnesemia was likely due to polypharmacy including semaglutide, albeit with a delayed relationship to discontinuation of this GLP-1RA, due to nausea and vomiting. Case Report: A 73-year-old woman with type 2 diabetes treated with several oral medications known to reduce serum magnesium (metformin, gliclazide, sitagliptin, esomeprazole) presented after an unwitnessed collapse at home without premonitory symptoms. She had discontinued low-dose semaglutide (0.25 mg subcutaneous weekly) 2 weeks beforehand, and her gastrointestinal adverse effects had largely resolved. She was found to have an undetectable serum magnesium (<0.3 mmol/L) and hypocalcemia. She responded to electrolyte replacement and was discharged well 2 days later. Three weeks after discharge, her serum magnesium and calcium concentrations were within the reference range, on regular oral…
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