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.

INVESTIGATIONS:

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.

DIAGNOSIS:

Gitelman's syndrome and hyperkalemia secondary to acute renal failure plus exogenous potassium supplementation.

MANAGEMENT:

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: David R Phillips, Kashif I Ahmad, Sarah J Waller, Peter Meisner, Fiona E Karet
• Journal: Nature clinical practice. Nephrology (Nat Clin Pract Nephrol) Vol. 2 Issue 6 Pg. 340-6; quiz 347 (Jun 2006) ISSN: 1745-8323 [Print] England
• PMID: 16932456 (Publication Type: Case Reports, Journal Article)

Chemical References

• Insulin
• Sodium Chloride Symporters
• Magnesium
• Glucose
• Potassium
• Calcium Gluconate

Topics

• Acute Kidney Injury (complications, therapy)
• Bartter Syndrome (diagnosis)
• Calcium Gluconate (therapeutic use)
• Diagnosis, Differential
• Glucose (therapeutic use)
• Hemodiafiltration
• Humans
• Hypokalemia (diagnosis, etiology, therapy)
• Insulin (therapeutic use)
• Magnesium (therapeutic use)
• Male
• Middle Aged
• Potassium (blood, therapeutic use)
• Renal Tubular Transport, Inborn Errors (diagnosis, etiology, therapy)
• Sodium Chloride Symporters (genetics)
• Syndrome