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Báo cáo y học: "Gitelman’s syndrome with persistent hypokalemia - don’t forget licorice, alcohol, lemon juice, iced tea and salt depletion: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Gitelman’s syndrome with persistent hypokalemia - don’t forget licorice, alcohol, lemon juice, iced tea and salt depletion: a case report. | Knobel et al. Journal of Medical Case Reports 2011 5 312 http www.jmedicalcasereports.eom content 5 1 312 WV journalof medical l rCASE REPORTS CASE REPORT Open Access Gitelman s syndrome with persistent hypokalemia - don t forget licorice alcohol lemon juice iced tea and salt depletion a case report Urs Knobel1 Goli Modarres2 Markus Schneemann2 and Christoph Schmid1 Abstract Introduction Chronic hypokalemia is the main finding in patients with Gitelman s syndrome. Exogenous factors can trigger deterioration of the patient s condition and provoke clinical symptoms. We discuss the pathophysiology of and therapy for Gitelman s syndrome with a focus on dietary factors which may aggravate the disease. Case presentation We describe the case of a 31-year-old previously apparently healthy Caucasian Swiss man who presented to our hospital with gait disturbance of subacute onset and a potassium level of 1.5 mmol L. A detailed medical history revealed that he had been consuming large amounts of licorice in the form of Fisherman s Friend menthol eucalyptus lozenges . Despite discontinuing the intake of glycyrrhizinic acid his potassium level remained low. Biochemical investigations showed refractory hypokalemia and secondary hyperaldosteronism suggestive of Gitelman s syndrome. Despite treatment with supplementation of potassium and magnesium in combination with an aldosterone antagonist further clinically symptomatic episodes occurred. Triggers could be identified only by repeated detailed history taking. In response to the patient s dietary excesses ingestion of relevant amounts of alcohol lemon juice and iced tea his hypokalemia was aggravated and provoked clinical symptoms. Finally vomiting and failure to replace salt led to volume depletion and hypokalemic crisis with a plasma potassium level of 1.0 mmol L and paralysis with respiratory failure necessitating not only infusion of saline and potassium but also temporary mechanical ventilation. Conclusion Dietary preferences