title: Management of a severe case of Gitelman syndrome with poor response to standard treatment.
abstract: Gitelman syndrome is an autosomal recessive distal renal tubular disorder caused by defective sodium chloride transporters. Biochemically, it presents with hypokalaemic metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is usually managed with oral potassium supplements and potassium-sparing diuretics. We report a case of a 28-year-old woman whose condition worsened during pregnancy; she became resistant to standard management after delivery of her second child. She was managed in a specialist metabolic clinic through a comprehensive approach including perseverance with oral potassium supplement, weekly intravenous potassium and magnesium infusion, correction of vitamin D level and the offering of appropriate dietary advice; this controlled the patient's symptoms and prevented repeated hospital admissions. In this case report, we illustrate a patient's presentation and diagnosis with Gitelman syndrome, discuss triggers of exacerbation, review the relevant literature in terms of differential diagnoses and provide practical advice on the management of difficult cases in a specialist clinic.
authors.affiliation: Department of Clinical Biochemistry, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Koudsi
authors.affiliation: Department of Clinical Biochemistry, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: Stanka
authors.initials: S
authors.lastname: Nikolova
authors.affiliation: Department of Clinical Biochemistry, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: Vinita
authors.initials: V
authors.lastname: Mishra
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004032:Diet; D005260:Female; D053579:Gitelman Syndrome / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006760:Hospitalization; D006801:Humans; D007008:Hypokalemia / Q000188:drug therapy / Q000209:etiology; D007262:Infusions, Intravenous; D008274:Magnesium / Q000097:blood / Q000627:therapeutic use*; D008275:Magnesium Deficiency / Q000188:drug therapy / Q000209:etiology; D018977:Micronutrients / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications; D012720:Severity of Illness Index; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000209:etiology
chemical_list: D018977:Micronutrients; D014807:Vitamin D; D008274:Magnesium; D011188:Potassium