Hypocalcaemia and hyponatraemia masquerading the diagnosis of Gitelman syndrome
2019
Gitelman syndrome is the most common renal tubulopathy, recently exhibiting a dramatic rise of incidence in Asia.
A 50-year-old woman presented with vomiting, fatigue
and quadriparesis. Physical examination revealed a
positive Trousseau sign , hypotonia and areflexia.
Suspecting hypocalcaemia, she was given intravenous
10% calcium gluconate (10mL administered slowly over
10min) but her manifestations persisted. An exhaustive
laboratory work up revealed the diagnosis of Gitelman
syndrome.
The peculiarity of this case however, is entailed in its
coexistence with hypocalcaemia and hyponatraemia. In
addition, the age of primary presentation being 50 years
further culminates its atypicality. Multiple electrolyte imbalances were corrected by oral and intravenous supplementation and a high sodiumpotassium diet was advocated. Administration of spironolactone imposed a pitfall in the management of our patient due to exacerbation of pre-existing hyponatraemia. On follow-up, her electrolyte profile was stable and corresponding symptoms were alleviated.
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