#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Gitelman syndrome in pregnancy - a severe hypokalemia with favorable perinatal prognosis


Authors: Z. Rušavý;  A. Hudec;  J. Karbanová;  V. Korečko;  R. Janů;  V. Kališ
Authors‘ workplace: Gynekologicko-porodnická klinika LF UK a FN, Plzeň, přednosta doc. MUDr. Z. Novotný, CSc.
Published in: Ceska Gynekol 2012; 77(5): 421-423

Overview

Gitelman syndrom is a rare congenital tubulopathy characterized by hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. We report a case of a 32-year-old patient admitted for asymptomatic hypokalemia and hypomagnesemia in the 30th week of gestation. A diagnosis of Gitelman syndrom was made and intravenous administration of potassium chloride in high doses combined with spironolactone was started. Despite intensive potassium supplementation (8 g/day), the serum potassium levels remained at the lower limit of normality throughout the pregnancy. The patient delivered a healthy female 2670 g/48 cm after labor induction in the 39th week of gestation. A summary of 22 so far published cases of Gitelman syndrome in pregnancy is presented. The analysis of published case studies suggests a need for ion supplementation, reduction of urinary potassium wasting, monitoring of fetal well-being and amniotic fluid levels. Pregnancy has a very favorable perinatal prognosis despite critical serum levels of potassium and magnesium throughout the pregnancy.

Key words:
Gitelman syndrome, hypokalemia, hypomagnesemia, pregnancy.


Sources

1. Al-Balas, M., Bozzo P, Einarson A. Use of diuretics during pregnancy. Can Fam Physician. 2009, 55 (1), p. 44–5

2. Basu, A., Dillon, RD., Taylor, R., et al. Is normalisation of serum potassium and magnesium always necessary in Gitelman syndrome for a successful obstetric outcome? BJOG, 2004, 111 (6), p. 630–634.

3. Daskalakis, G., Marinopoulos, S., Mousiolis, A., et al. Gitelman syndrome-associated severe hypokalemia and hypomagnesemia: case report and review of the literature. J Matern Fetal Neonatal Med, 2010, 23 (11), p. 1301–1304.

4. Davison, JM., Dunlop, W. Renal haemodynamics and tubular function in normal human pregnancy. Kidney Int, 1980, 18, p. 152.

5. de Arriba, G., Sánchez-Heras, M., Basterrechea, MA. Gitelman syndrome during pregnancy: a therapeutic challenge. Arch Gynecol Obstet, 2009, 280 (5), p. 807–809.

6. de Haan, J., Geers, T., Berghout, A. Gitelman syndrome in pregnancy. Int J Gynaecol Obstet, 2008, 103, p. 69–71.

7. Ducarme, G., Davitian, C., Uzan, M., et al. Syndrome de Gitelman et grossesse ą propos d’un cas et revue de la littérature. Rev Esc Enferm US, 2005, 39 (3), p. 288–295.

8. Groves, TD., Corenblum, B. Spironolactone therapy during human pregnancy. Am J Obstet Gynecol, 1995, 172 (5), p. 1655–1656.

9. Graziani, G., Fedeli, C., Moroni, L., et al. Gitelman syndrome: pathophysiological and clinical aspects. QJM, 2010, 103 (10), p. 741–748.

10. Jones, JM., Dorrel, S. Outcome of two pregnancies in a patient with Gitelman’s syndrome: a case report. J Matern Fetal Investig, 1998, 8, p. 147–148.

11. Kučera, J., Kubelík, J., et al. Nové tabulky normální porodní hmotnosti pro Českou republiku. Čs Pediatrie, 1999, 54 (10), s. 572–578.

12. Kwan, TK., Falk, MC. Second pregnancy outcome in a patient with Gitelman syndrome without the use of parenteral electrolyte supplementation. Aust N Z J Obstet Gynaecol, 2011, 51 (1), p. 94–95.

13. Lakhi, N., Jones, J., Govind, A. Fetal demise despite normalisation of serum potassium in Gitelman syndrome. Case report and literature review. Aust N Z J Obstet Gynaecol, 2010, 50 (3), p. 301–302.

14. Mascetti, L., Bettinelli, A., Simonetti, GD., et al. Pregnancy in inherited hypokalemic salt-losing renal tubular disorder. Obstet Gynecol, 2011, 117 (2), p. 512–516.

15. Morton, A., Panitz, B., Bush, A. Eplerenone for Gitelman syndrome in pregnancy. Nephrology (Carlton), 2011, 16 (3), p. 349.

16. Shanbhag, S., Neil, J., Howell, C. Anaesthesia for caesarean section in a patient with Gitelman’s syndrome. Int J Obstet Anesth, 2010, 19 (4), p. 451–453.

17. Slováček, L., Čáp, J., Ceeová, V. Gitelmanův syndrom. Inter Med, 2006, 1, s. 33–35.

18. Srinivas, SK., Sukhan, S., Elovitz, MA. Nausea, emesis, and muscle weakness in a pregnant adolescent. Obstet Gynecol, 2006, 107, p 481–484.

19. Talaulikar, GS., Falk, MC. Outcome of pregnancy in a patient with Gitelman syndrome: a case report. Nephron Physiol, 2005, 101, p. 35–38.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 5

2012 Issue 5

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#