Gladziwa U, Schwarz R, Gitter AH, Bijman J, Seyberth H, Beck F, Ritz E, Gross P
Chronic hypokalemia of adults: Gitelman's syndrome is frequent but classical Bartter's syndrome is rare

Nephrol Dial Transplant (Sep) 10:1607-1613 1995

Gitelman's syndrome (renal hypokalemia accompanied by hypomagnesemia, hypermagnesuria and hypocalciuria) has been described in adults, but its frequency, esp. compared to that of classical Bartter's syndrome is unknown. Twenty seven adult patients with hypokalemia were evaluated. 15 patients had either diuretic abuse (high urine Cl; + urine for diuretics), surreptitious vomiting (low urine Cl), laxative abuse (low urine Na), or RTA. The other 12 patients underwent extensive evaluation including PRA/aldo, 24h urinary studies, and tests for urinary dilution, concentration, and pH. These patients were found to have high PRA and aldo, mild metabolic alkalosis, hypokalemia, hypomagnesemia, and high potassium and magnesium excretion. Distal fractional chloride reabsorption (CH2O/(CH2O+CCl), minimal and maximal urine osmolality were normal. All patients were hypocalciuric (mean UCaV 36 mg/24h) which is characteristic of Gitelman's syndrome. Six patients had + family history. K content of stimulated sweat was increased.

In adults, Gitelman's syndrome is probably much more common than classic Bartter's (who have normal or elevated urinary calcium excretion as well as defects in Cl reabsorption and urine concentration). Therapy with high doses of potassium chloride (with or without magnesium supplements) is generally effective. (Leehey)

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Acidosis/alkalosis : Hypokalemia
Acidosis/alkalosis : Metabolic alkalosis