Recurrent episodes of confusion, weakness, and unsteadiness

[...]indapamide was changed to amlodipine. No definitive diagnosis was made.Table 1 Blood investigations in relation to timing of presentation Test Six weeks previously Current presentation Reference range Prothrombin time (s) 11.7 11-13.5 Activated partial thromboplastin time (s) 29.7 22-36 Albumin...

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Bibliographic Details
Published in:BMJ (Online) 2023-06, Vol.381, p.p1073-1073
Main Authors: Winnifrith, Tabitha, Ibitoye, Richard
Format: Article
Language:English
Subjects:
Alanine transaminase
Alcohol use
Alkaline phosphatase
Asymptomatic
Bilirubin
C-reactive protein
Diuretics
Endgames
Ferritin
Folic acid
Glomerular filtration rate
Hemoglobin
Hypertension
Hypokalemia
Indapamide
Laboratories
Magnesium
Nutrition
Prothrombin
Proton pump inhibitors
Protons
Risk factors
Small intestine
Thromboplastin
Tomography
Vitamin B
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Summary:[...]indapamide was changed to amlodipine. No definitive diagnosis was made.Table 1 Blood investigations in relation to timing of presentation Test Six weeks previously Current presentation Reference range Prothrombin time (s) 11.7 11-13.5 Activated partial thromboplastin time (s) 29.7 22-36 Albumin (g/L) 42 43 35-50 Bilirubin (μmol/L) 9 9 < 21 Alanine aminotransferase (U/L) 69 53 < 35 Alkaline phosphatase (U/L) 93 83 30-139 Haemoglobin (g/L) 140 132 115-165 Mean corpuscular volume (fL) 105.0 109.4 80-100 Urea (mmol/L) 3.6 2.8 2.5-7.8 Sodium (mmol/L) 129 143 133-146 Potassium (mmol/L) 4.1 3.4 3.5-5.3 Folate (μg/L) 1.8 > 4.0 B12 (ng/L) 1034 180-1000 Magnesium (mmol/L) 0.44 0.7-1.0 Calcium (mmol/L) 2.38 2.20-2.63 Estimated glomerular filtration rate (mL/min/1.73m2) 87 86 > 60 Ferritin (μg/L) 722 10-300 C reactive protein (mg/L) 4 3 < 5 Thyroid stimulating hormone (mU/L) 1.5 0.27-4.2 A further episode occurred in her GP’s consulting room. Proton pump inhibitor use is also associated with hypomagnesaemia, possibly through impaired gastrointestinal absorption.9 High alcohol intake may lead to hypomagnesaemia through poor nutrition and increased renal and gastrointestinal loss.15 The patient had several of these risk factors: high alcohol intake, previous small bowel resection, proton pump inhibitor use, and use of diuretics.
ISSN:1756-1833
1756-1833
DOI:10.1136/bmj.p1073