Seizure-like Symptoms Induced by Hypomagnesemia in a Patient with Incomplete Small Bowel Obstruction; A Case Report.

Background: Seizure-like symptoms are rare in older patients without brain damage. Small bowel obstruction is a common clinical disorder for older patients that can cause electrolyte disturbances and nutritional disorders. Hypomagnesemia is a frequently overlooked electrolyte disorder. Moreover, magnesium deficiency can lead to severe seizure-like symptoms.

Case report: An 85-year-old man was admitted to the hospital with weakness and slow movement. Shortly after hospitalization, he experienced incomplete small bowel obstruction; thus, parenteral nutrition and intravenous esomeprazole were administered. When intestinal obstruction was relieved, the patient suddenly experienced seizure-like symptoms three times, and 24-h electroencephalogram did not capture any epileptiform pattern. After excluding other causes, we considered serum magnesium deficiency as a diagnosis. Low serum magnesium levels were related to a shortage of absorption due to small bowel obstruction, excess excretion of renal dysfunction, and the use of proton pump inhibitor. However, the exact mechanism underlying the hypomagnesemia-induced seizure-like activity remained unclear. After adjusting the nutritional support and magnesium supplementation, the patient's serum magnesium level returned to normal, and he was free of seizure-like activity.

Conclusion: Hypomagnesemia is often asymptomatic, but it can lead to severe seizure-like symptoms. It is important to pay attention to the serum magnesium level and nutritional intake in patients with an incomplete small bowel obstruction.