# Situation: A 41-year-old man with long-standing gastroesophageal reflux disease (GERD) and a large sliding hiatal hernia is being prepared for laparoscopic fundoplication. A coronary stent was placed 5 months ago. He has taken omeprazole for 4 years. Which adverse effect is linked to long-term proton pump inhibitor (PPI) use?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630469  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 41-year-old man with long-standing gastroesophageal reflux disease (GERD) and a large sliding hiatal hernia is being prepared for laparoscopic fundoplication. A coronary stent was placed 5 months ago.

He has taken omeprazole for 4 years. Which adverse effect is linked to long-term proton pump inhibitor (PPI) use?

## 보기

1. High serum potassium
2. Low serum magnesium **✔ 정답**
3. High serum calcium
4. Low blood glucose

**정답: 2**

## 해설

Long-term proton pump inhibitor use is linked to hypomagnesemia, vitamin B12 deficiency, fractures, and Clostridioides difficile infection. For this reason the lowest effective dose is used and the need for the drug is reviewed regularly.

## 심화 해설

Long-term PPI risks
The client has taken omeprazole, a proton pump inhibitor (PPI), for 4 years. PPIs are highly effective for gastroesophageal reflux disease, but long-term use carries recognized risks. Long-term proton pump inhibitor use is linked to hypomagnesemia, vitamin B12 deficiency, fractures, and Clostridioides difficile infection. Of the options, low serum magnesium is the recognized adverse effect.

Why magnesium falls
PPIs are thought to reduce the active absorption of magnesium in the intestine through specific transport channels, which depend on the acidity of the gut. Over months to years, total body magnesium can fall. Hypomagnesemia may cause muscle cramps, tremor, tetany, seizures, and cardiac dysrhythmias, and it can also cause low calcium and low potassium that do not correct until magnesium is replaced. This matters for a client facing surgery, since electrolyte imbalance raises the risk of dysrhythmias under anesthesia.

| Long-term PPI risk | Mechanism |
| --- | --- |
| Hypomagnesemia | Reduced intestinal magnesium absorption |
| Vitamin B12 deficiency | Acid is needed to release B12 from food protein |
| Fractures | Reduced calcium absorption |
| Clostridioides difficile infection | Loss of the gastric acid barrier against bacteria |

Why the other options are wrong
PPIs are not a recognized cause of high serum potassium. They reduce calcium absorption and are linked to fractures, not to high calcium. They do not lower blood glucose. Each distractor names an electrolyte or metabolic change, so the student must know the specific association with magnesium.

Watch out! High calcium is a tempting distractor because PPIs are linked to bone problems. The link runs the other way: reduced calcium absorption and weaker bones, not hypercalcemia.

Nursing implications
Because of these risks, the lowest effective dose is used and the need for the drug is reviewed regularly. The nurse checks magnesium levels when ordered, especially in clients also taking diuretics, and teaches clients to report cramps, palpitations, or persistent diarrhea. Key point! Long-term PPI therapy can cause hypomagnesemia, B12 deficiency, fractures, and C. difficile infection; use the lowest effective dose and review the need regularly.

## 임상 시나리오

Long-Term PPI UseOmeprazole for 4 years
Long-term proton pump inhibitor use is linked to hypomagnesemia, vitamin B12 deficiency, fractures, and C. difficile infection.

Low magnesium can cause cramps, tremor, seizures, and dysrhythmias and can make low calcium and potassium hard to correct.

Use the lowest effective dose, review the need regularly, and monitor magnesium when ordered.

CautionPPIs do not cause high potassium, high calcium, or low glucose; they reduce calcium absorption.

## 핵심 개념

- **Proton pump inhibitor** — A drug that blocks the gastric proton pump to reduce stomach acid, such as omeprazole or pantoprazole.
- **Hypomagnesemia** — A low serum magnesium level that can cause cramps, tremor, seizures, and dysrhythmias.
- **Clostridioides difficile** — A bacterium that causes colitis and diarrhea, more common when stomach acid or gut flora are disturbed.
- **Fundoplication** — Surgery that wraps the upper stomach around the lower esophagus to prevent reflux.

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