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A Case of Gitelman's Syndrome

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Stanley Medical College, Department of Medicine
Health & Medicine
1 of 40
- Prof. Dr. Maheshkumar ‘s Unit Dr. Israel
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RBS : 323 mg% BUN:58 S. Cr : 1.1 Na+ : 138 K+: 3.1 PVT Reports Na + : 137 K+ : 2.17 HCO3- : 23.7 Cl- : 93.4 FBS : 109 mg/dl PLBS : 112 mg /dl
ECG
 
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Hypokalemia can only occur for four reasons: ,[object Object],[object Object],[object Object],[object Object]
Hypokalemia Urinary K + excretion < 15 mmol/d Assess acid-base status Metabolic acidosis Metabolic alkalosis Lower gastronitestinal K + loss Remote diuretic use Remote vomiting K + loss via sweat > 15 mmol/d Assess K + secretion TTKG > 4 TTKG < 2 Acid-base status Na + -wasting nephropathy Osmotic diuretic Diuretic Metabolic acidosis Diabetic ketoacidosis Proximal (type 2) RTA Distal (type 1) RTA Amphotericin B Metabolic alkalosis Hypertension ? Yes Mineralocorticoid excess Liddle’s syndrome No Vomiting Bartter’s syndrome Exclude diuretic abuse Hypomagnesemia
Causes of hypokalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Increased potassium entry into cells: ,[object Object],[object Object]
Extra-renal losses of potassium:
Gastrointestinal losses of potassium ,[object Object],[object Object]
Hypokalemia from loss of gastric fluid. ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object]
The kidney and potassium ,[object Object],[object Object]
Renal losses of potassium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal losses of potassium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What data do we want to diagnose the cause of hypokalemia in this pt? ,[object Object],[object Object],[object Object],[object Object]
Therefore: ,[object Object],[object Object],[object Object],[object Object]
Bartter’s and Gitelman’s syndromes ,[object Object],[object Object],[object Object]
 
Bartter’s and Gitelman’s Syndromes ,[object Object],[object Object],[object Object],[object Object]
Gitelman’s syndrome ,[object Object],[object Object],[object Object],[object Object]
Gitelman’s syndrome ,[object Object],[object Object],[object Object]
©2005 UpToDate ® • www.uptodate.com • Contact Us
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Gitelman’s syndrome: treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
General comments about the treatment of hypokalemia ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 

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