*, Basavaprabhu Achappa and Gopinath, Bhargav and Chauhan, Nupur (2019) Hypocalcaemia and hyponatraemia masquerading the diagnosis of Gitelman syndrome. BMJ Case Reports, 12 (1). pp. 1-4. ISSN 1757-790X

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Abstract

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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