{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:54:57Z","timestamp":1781639697839,"version":"3.54.5"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Asterixis, or \u201cflapping tremor,\u201d is typically described in the setting of metabolic encephalopathies such as hepatic or uremic encephalopathy. However, electrolyte disturbances can also precipitate asterixis, though this is less commonly reported. Hypomagnesemia is an underrecognized cause, particularly in older adults with type 2 diabetes mellitus, where magnesium depletion is multifactorial. Reporting such cases is important to highlight the diagnostic challenge and the potential for fully reversible neurological manifestations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We describe a 72-year-old woman with long-standing type 2 diabetes mellitus, hypertension, and stage 3 chronic kidney disease, who presented with tingling in all four limbs for 8 months and muscle cramps for 1 month. On examination, she exhibited bilateral asterixis, with otherwise normal neurological findings. Brain imaging showed chronic ischemic changes without basal ganglia involvement, and electrocardiography revealed prolonged QTc. Laboratory studies identified hypomagnesemia (serum magnesium 1.1\u00a0mg\/dL), while serum calcium and potassium levels were normal. No gastrointestinal losses, drug use, or alcohol history were evident, suggesting diabetes-related magnesium depletion as the underlying cause. After magnesium supplementation, her asterixis resolved completely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case emphasizes hypomagnesemia as a rare but reversible cause of asterixis. In older adults with diabetes, magnesium depletion is multifactorial and underdiagnosed. Early recognition and correction are crucial to prevent complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07281-5","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T01:04:42Z","timestamp":1772672682000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flummoxed by the flaps \u2013 case report"],"prefix":"10.1186","volume":"26","author":[{"given":"Bhavika","family":"Pahwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen Kumar","family":"Tasir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan Savio","family":"Sequeira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind","family":"Khade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"issue":"1","key":"7281_CR1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1136\/practneurol-2016-001393","volume":"17","author":"MA Ellul","year":"2017","unstructured":"Ellul MA, Cross TJ, Larner AJ, Asterixis. Pract Neurol. 2017;17(1):60\u20132.","journal-title":"Pract Neurol"},{"issue":"2","key":"7281_CR2","doi-asserted-by":"publisher","first-page":"115","DOI":"10.4103\/0022-3859.180572","volume":"62","author":"R Agarwal","year":"2016","unstructured":"Agarwal R, Baid R, Asterixis. J Postgrad Med. 2016;62(2):115\u20137.","journal-title":"J Postgrad Med"},{"issue":"5","key":"7281_CR3","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/S0272-6386(12)80667-6","volume":"24","author":"SM Al-Ghamdi","year":"1994","unstructured":"Al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: pathophysiologic and clinical overview. Am J Kidney Dis. 1994;24(5):737\u201352.","journal-title":"Am J Kidney Dis"},{"issue":"6","key":"7281_CR4","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1053\/j.ajkd.2023.10.017","volume":"83","author":"EA Adomako","year":"2024","unstructured":"Adomako EA, Alan SL. Magnesium disorders: core curriculum 2024. Am J Kidney Dis. 2024;83(6):803\u201315.","journal-title":"Am J Kidney Dis"},{"key":"7281_CR5","doi-asserted-by":"publisher","first-page":"617374","DOI":"10.3389\/fphys.2020.617374","volume":"11","author":"Y Yang","year":"2021","unstructured":"Yang Y, Chen C, Duan P, Thapaliya S, Gao L, Dong Y, Yin X, Yang X, Zhang R, Tan R, Hui S. The ECG characteristics of patients with isolated hypomagnesemia. Front Physiol. 2021;11:617374.","journal-title":"Front Physiol"},{"key":"7281_CR6","doi-asserted-by":"crossref","unstructured":"Baoum SO, Al Matrafi TM, Alshaikh TT, Alluhaibi HN, Alkhaldi GN, Alotaibi HN, et al. Common electrocardiogram manifestations in electrolyte imbalance. Int J Community Med Public Health. 2022;9:xxx-xx.","DOI":"10.18203\/2394-6040.ijcmph20222384"},{"key":"7281_CR7","volume-title":"Neurology in clinical practice","year":"2022","unstructured":"Bradley WG, Daroff RB, editors. Neurology in clinical practice. 8th ed. Philadelphia: Elsevier; 2022.","edition":"8"},{"issue":"4","key":"7281_CR8","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1097\/MNH.0000000000000238","volume":"25","author":"ZS Agus","year":"2016","unstructured":"Agus ZS. Mechanisms and causes of hypomagnesemia. Curr Opin Nephrol Hypertens. 2016;25(4):301\u20137.","journal-title":"Curr Opin Nephrol Hypertens"},{"issue":"3","key":"7281_CR9","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1210\/endrev\/bnac028","volume":"44","author":"LJ Oost","year":"2023","unstructured":"Oost LJ, Tack CJ, de Baaij JH. Hypomagnesemia and cardiovascular risk in type 2 diabetes. Endocr Rev. 2023;44(3):357\u201378.","journal-title":"Endocr Rev"},{"issue":"1","key":"7281_CR10","first-page":"44","volume":"35","author":"LB Kurniawan","year":"2024","unstructured":"Kurniawan LB. Triglyceride-glucose index as a biomarker of insulin resistance, diabetes mellitus, metabolic syndrome, and cardiovascular disease: a review. Ejifcc. 2024;35(1):44.","journal-title":"Ejifcc"},{"issue":"10","key":"7281_CR11","doi-asserted-by":"publisher","first-page":"107402","DOI":"10.1016\/j.jdiacomp.2019.06.007","volume":"33","author":"RD Toto","year":"2019","unstructured":"Toto RD, Goldenberg R, Chertow GM, Cain V, Stef\u00e1nsson BV, Sj\u00f6str\u00f6m CD, Sartipy P. Correction of hypomagnesemia by dapagliflozin in patients with type 2 diabetes: A post hoc analysis of 10 randomized, placebo-controlled trials. J Diabetes Complicat. 2019;33(10):107402.","journal-title":"J Diabetes Complicat"},{"issue":"5","key":"7281_CR12","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1053\/j.ajkd.2023.11.006","volume":"83","author":"CV Shah","year":"2024","unstructured":"Shah CV, Sparks MA, Lee CT. Sodium\/glucose cotransporter 2 inhibitors and magnesium homeostasis: a review. 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