Severe hypokalemia in a child with mild gastroenteritis


  • Catarina Faria Department of Pediatrics, Hospital de Braga
  • Carina Ferreira Department of Pediatrics, Hospital de São Teotónio
  • Alzira Sarmento Pediatric Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Sara Gonçalves Pediatric Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Paula Rocha Pediatric Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Carlos Duarte Department of Pediatrics, Hospital da Luz Arrábida
  • Conceição Mota Department of Pediatric Nephrology, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto



hypokalemia, electrolyte imbalance, tubulopathy, Gitelman syndrome


Background: Hypokalemia (serum potassium below 3.5 mmol/L) may be caused by several mechanisms. Severe hypokalemia must be immediately managed, as it can have important cardiac repercussions.
Clinical case: A previously healthy eight-year-old female, with normal growth and normal-to-low blood pressure, was observed due to persistent abdominal pain, anorexia, and fever two days after overcoming a mild gastroenteritis episode. Serum biochemistry revealed severe hypokalemia (1.8 mmol/L), hypomagnesemia, and metabolic alkalosis. The patient was admitted to the Pediatric Intensive Care Unit for correction of electrolyte imbalance, cardiac monitoring, and investigation. Complementary studies included a spot urine ionogram that revealed inappropriate potassium wasting. Ionic correction was achieved by both intravenous and oral supplementation plus spironolactone. Genetic testing was positive for Gitelman syndrome.
Discussion/Conclusion: Suspicion of complex causes should be raised and a comprehensive approach undertaken upon a discrepancy between clinical history and hypokalemia severity.


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How to Cite

Faria C, Ferreira C, Sarmento A, Gonçalves S, Rocha P, Duarte C, Mota C. Severe hypokalemia in a child with mild gastroenteritis. REVNEC [Internet]. 2019Oct.14 [cited 2024Jul.18];28(3):154-8. Available from:



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