Abstract #1408162: Comparison of Different Doses of Sodium-Glucose Ttransporter-2 Inhibitors (SGLT2i) to SGLT2i with Magnesium Infusions for Refractory Hypomagnesaemia in a Patient with Monogenic Diabetes Type-5 (MODY-5)

MODY-5 is a rare autosomal dominant form of monogenic diabetes attributed to deletions chromosome 17q12 with impaired expression HNF1β (Hepatocyte Nuclear Factor 1 homeobox Beta. The deficient HNF1B down regulated the FXYD2. Refractory hypomagnesemia commonly observed in patients due downregulated FXYD2 which blocked encoding γ (gamma) subunit Na+-K+-ATPase and indirectly led hypomagnesemia. SGLT2i have been associated small but significant increases serum magnesium (sMg) levels diabetes. We report our patient's experience comparing use at different doses Mg infusions for refractory patient MODY-5. 29 y/o Caucasian female family history young onset was diagnosed age 19 years old when she found kidney cysts that were noted incidentally on MRI spine. She presents clinic hypertension, catamenial headaches, hyperuricemia, oral supplements (400mg twice day) wasting syndrome, congenital pancreatic atresia exocrine insufficiency. sMg <1.0mg/dl 2 symptomatic it such as fatigue, headaches muscle aches. Most lately, could not tolerate more than 1000mg day diarrhea. Prior starting her fractional excretion (FEMg) 14.5% (normal FEMg <4% setting hypomagnesemia). started canagliflozin 100mg titrated 300mg; has improved level from 0.9 mg/dl 1.2mg/dl stable this dose weeks. data available change canagliflozin. also amiloride 5mg daily. dropped <1 md/dL stopped insurance again after empagliflozin. On 10mg empagliflozin compared 25mg changed remained 1.1mg/dl 10% 7.25%. continued symptoms hypomagnesemia, so sulfate 2gm 100ml normal saline infused over 12hrs 3 times week 6 months. Her infusion, they wear off quickly. Magnesium 1.5mg/dl 12.6%. Did improve. Lately treatment burden decreased per week. improve syndrome. >1 mg/dL SGLT2i. There no difference low versus high empagliflozin, an improvement FEMg. Adding infusion slightly sMg, expense disease treatment.