Patient 1 was a 59-year-old female with a background history of diabetes mellitus and hypertension. Her medications included perindopril, amlodipine, metformin and gliclazide. She was diagnosed with pulmonary tuberculosis one month prior to admission (PTA), having presented with 3-month history of fever, cough and constitutional symptoms. She was started on antituberculosis treatment. Unfortunately, she developed epigastric pain and vomiting and was started on pantoprazole a month later. She requested at-own-risk discharge from hospital on two days after starting the PPI.
Three days later, she was admitted again due to persistent vomiting and epigastric pain. On her 1st hospital day (HD) she developed an episode of narrow-complex tachycardia with prolonged QTc and went into respiratory distress. She required intubation and was transferred to the intensive care unit. Her blood investigations showed multiple electrolyte abnormalities, including hypomagnesaemia, hypocalcaemia, hypophosphatemia and hypokalemia. She was given multiple doses of parenteral magnesium sulfate, calcium gluconate and potassium chloride to correct those deficiencies. However, the serum magnesium, potassium and calcium levels failed to return to normal despite multiple corrections given.
On the 3rd HD, pantoprazole was discontinued. Thereafter, the serum levels of magnesium, potassium and calcium started to respond to the IV corrections and slowly returned to normal. (Table 1 and Figure 1). Unfortunately, the patient developed hospital-acquired pneumonia and succumbed to septicemia two weeks later.