A patient with long-term Proton Pump Inhibitor (PPI) therapy develops refractory hypomagnesemia. Analyze the mechanism by which PPIs can contribute to magnesium deficiency and indicate appropriate nutritional or clinical responses.

• A. PPIs convert magnesium to an unusable form bound in bone, which requires immediate calcium supplementation to mobilize magnesium stores.
• B. PPIs cause sulfur depletion by binding sulfur-containing amino acids in the stomach, and replacing sulfur with supplements will rapidly correct magnesium levels.
• C. PPIs increase renal excretion of magnesium causing hypomagnesemia; therefore, high-dose thiazide diuretics are the preferred corrective measure.
• D. PPIs can reduce intestinal magnesium absorption leading to hypomagnesemia; clinical response includes checking serum magnesium, consider magnesium supplementation or altering PPI therapy if appropriate, and increase dietary magnesium while monitoring renal function and electrolytes.

Answer: (D)