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