title: A serum potassium level above 10 mmol/l in a patient predisposed to hypokalemia.
abstract: BACKGROUND
  A 58-year-old man, previously diagnosed with Bartter's syndrome, presented with a short history of vomiting, diarrhea and weakness. He had severe hyperkalemia (serum potassium levels >10 mmol/l), which was successfully managed. Post hoc investigation suggested that the patient had Gitelman's rather than Bartter's syndrome.
  
  
  METHODS
  Physical examination, urine and blood analyses, chest radiography, electrocardiogram, renal ultrasound, and genetic analysis focusing on the SLC12A3 gene, which encodes the thiazide-sensitive Na/Cl cotransporter.
  
  
  METHODS
  Gitelman's syndrome and hyperkalemia secondary to acute renal failure plus exogenous potassium supplementation.
  
  
  RESULTS
  Intravenous calcium gluconate, insulin and dextrose administration. Temporary continuous venovenous hemodiafiltration. Genetic confirmation of the underlying molecular defect. Long-term treatment for Gitelman's syndrome with oral potassium and magnesium supplements and epithelial sodium channel-blocking drugs. Review of patient education regarding renal salt-wasting syndromes.
authors.affiliation: Courtyard Clinic, St George's Hospital NHS Trust, London.
authors.forename: David R
authors.initials: DR
authors.lastname: Phillips
authors.forename: Kashif I
authors.initials: KI
authors.lastname: Ahmad
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Waller
authors.forename: Peter
authors.initials: P
authors.lastname: Meisner
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Karet
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000628:therapy; D001477:Bartter Syndrome / Q000175:diagnosis; D002125:Calcium Gluconate / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005947:Glucose / Q000627:therapeutic use; D017583:Hemodiafiltration; D006801:Humans; D007008:Hypokalemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007328:Insulin / Q000627:therapeutic use; D008274:Magnesium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood* / Q000627:therapeutic use; D015499:Renal Tubular Transport, Inborn Errors / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D049992:Sodium Chloride Symporters / Q000235:genetics; D013577:Syndrome
chemical_list: D007328:Insulin; D049992:Sodium Chloride Symporters; D008274:Magnesium; D005947:Glucose; D011188:Potassium; D002125:Calcium Gluconate