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An 80-year-old man with well controlled hypertension for eight years and monoclonal IgM gammopathy was referred to our hospital in May 2010 due to persistent elevation of serum creatinine(s-Cr). At our hospital, urine and blood tests showed no abnormal findings as BUN and Cr were 15.0 mg/dL and 0.91 mg/dL, respectively. In contrast the referring hospital had obtained values of 10.4 mg/dL and 4.8 mg/dL, respectively. This discrepancy was replicated when s-Cr was measured in another sample from this patient using the enzyme assay kits employed by the referring hospital and our hospital. High-performance liquid chromatography (HPLC), which is the standard method for measuring s-Cr, gave a value in the normal range. After removing high molecular weight proteins (>3,000 D)from the serum sample, the s-Cr levels measured with the respective kits were similar. Since elevation of s-Cr was linked to that of IgM at the referring hospital, we diagnosed the patient as having pseudohypercreatininemia with monoclonal IgM gammopathy.

We report a case of a 59-year old Japanese woman with short bowel syndrome, whose hypokalemia and hypocalcemia were successfully treated with magnesium (Mg) supplementation. Two years previously, she underwent Mile's operation for advanced rectal cancer, which could have been the cause of subsequent extensive resection of the small intestine by strangulation. After serial resection, she gradually developed chronic diarrhea and anorexia. Three weeks before admission, she developed general fatigue and tetany, and was hospitalized at another hospital. On admission, her serum K and Ca were 2.5 mEq/L and 4.3 mg/dL, respectively, hence regular fluid therapy containing potassium (K) and calcium (Ca) was provided following admission. However, her hypokalemia and hypocalcemia persisted, and she also displayed renal dysfunction and thereafter was transferred to our department for further evaluation and treatment. Since the laboratory tests revealed severe hypomagnesemia (0.4 mg/dL), we started intravenous Mg supplementation together with fluid therapy containing K and Ca. After the combination therapy, her clinical symptoms and electrolyte disorders were remarkably improved within a week. As Mg is essential for PTH secretion in response to hypocalcemia and to inhibit the K channel activity that controls urinary K excretion, hypomagnesemia can cause hypocalcemia and hypokalemia, which is refractory to repletion therapy unless Mg is administered. Therefore, for patients who present with signs of Mg deficiency, early and accurate diagnosis of Mg deficiency should be made and corrected.