Severe hypokalemia in a child with mild gastroenteritis
Keywords: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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