A serum potassium level above 10 mmol/l in a patient predisposed to hypokalemia.
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.
Phillips
David R
DR
Courtyard Clinic, St George's Hospital NHS Trust, London.
Ahmad
Kashif I
KI
Waller
Sarah J
SJ
Meisner
Peter
P
Karet
Fiona E
FE
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
D007328:Insulin; D049992:Sodium Chloride Symporters; D008274:Magnesium; D005947:Glucose; D011188:Potassium; D002125:Calcium Gluconate