Severe hypokalemia in a child with mild gastroenteritis

Authors

  • 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

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v28.i3.15338

Keywords:

hypokalemia, electrolyte imbalance, tubulopathy, Gitelman syndrome

Abstract

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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References

1. Zieg J, Gonsorcikova L, Landau D. Current views on the diagnosis and management of hypokalaemia in children. Acta Paediatr. 2016; 105:762-72.

2. Somers M, Traum A. Hypokalemia in children. [UpToDate website]. August 22, 2016. (Accessed March 20, 2018) Available at: https://www.uptodate.com/contents/hypokalemia-inchildren.

3. Koudsi L, Nikolova S, Mishra V. Management of a severe case of Gitelman syndrome with poor response to standard treatment. BMJ Case Rep. 2016 Published online [Feb 17 2016]: doi:10.1136/bcr-2015-212375.

4. Bockenhauer D, Zieg J. Electrolyte disorders. Clin Perinatol. 2014; 41:575-90.

5. Knoers NV, Levtchenko EN. Gitelman syndrome. Orphanet J Rare Dis. 2008; 3:22.

6. Blanchard A, Bockenhauer D, Bolignano D, Calò L, Cosyns E, et al. Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2017; 91:24-33.

7. Emmet M, Ellison D. Bartter and Gitelman syndromes. [UpToDate website]. February 7, 2018. (Accessed March 20, 2018). Available at: https://www.uptodate.com/contents/bartter-and-gitelman-syndromes.

8. Colussi G, Bettinelli A, Tedeschi S, De Ferrari M, Syrén M, et al. A thiazide test for the diagnosis of renal tubular hypokalemic disorders. Clin J Am Soc Nephrol. 2007; 2:454-60.

9. Filippatos T, Rizos C, Tzavella E, Elisaf M. Gitelman syndrome: an analysis of the underlying pathophysiologic mechanisms of acid-base and electrolyte abnormalities. Int Urol Nephrol. 2018; 50:91-6.

10. Huang C, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol. 2007;18:2649–52.

11. Lin S, Cheng N, Hsu Y, Halperin M. Intrafamilial phenotype variability in patients with Gitelman syndrome having the same mutations in their thiazide-sensitive sodium/chloride cotransporter. Am J Kidney Dis. 2004; 43:304-12.

12. Fremont O, Chan J. Understanding Bartter syndrome and Gitelman syndrome. World J Pediatr. 2012; 8:25-30.

13. Cortesi C, Lava SA, Bettinelli A, Tammaro F, Giannini O, Caiata- Zufferey M, et al. Cardiac arrhythmias and rhabdomyolysis in Bartter-Gitelman patients. Pediatr Nephrol. 2010; 25:2005-8.

14. Cruz D, Simon D, Nelson-Williams C, Farhi A, Finberg K, Burleson L, et al. Mutations in the Na-Cl cotransporter reduce blood pressure in humans. Hypertension. 2001; 37:1458-64.

15. Bettinelli A, Bianchetti MG, Girardin E, Caringella A, Cecconi M, Appiani AC, et al. Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic alkalosis: Bartter and Gitelman syndromes. J Pediatr. 1992; 120:38-43.

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Published

2019-10-14

How to Cite

1.
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 2024Sep.20];28(3):154-8. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/15338

Issue

Vol. 28 No. 3 (2019)

Section

Case Reports

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