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Micha G, Kalopita K, Theodorou S, Stroumpoulis K. Peripartum Management of Gitelman Syndrome for Vaginal Delivery: A Case Report and Review of Literature. Anesth Essays Res 2021; 15:146-148. [PMID: 34667363 PMCID: PMC8462432 DOI: 10.4103/aer.aer_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 11/14/2022] Open
Abstract
We describe the anesthetic management of a spontaneous vaginal delivery at 38 weeks' gestation in a 36-year-old patient with Gitelman syndrome (GS). GS is a rare autosomal recessive renal tubulopathy characterized by hypomagnesemia, hypocalciuria, and secondary aldosteronism, which results in hypokalemia and metabolic alkalosis. To minimize any increase in catecholamine levels and consequent risk of ventricular arrhythmias, a labor epidural analgesia was administered using ropivacaine and fentanyl, along with intravenous magnesium and potassium supplementation. Ropivacaine was substituted for routine bupivacaine to decrease the risk of drug-induced cardiotoxicity. In the event of a cesarean section, the anesthetic plan was to continue with top-up epidural anesthesia and in case of failure, to convert to general anesthesia using propofol and rocuronium for induction. Delivery outcome was successful and uneventful.
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Affiliation(s)
- Georgia Micha
- Department of Anaesthesiology and Pain Medicine, "Elena Venizelou" General Hospital of Athens, Athens, Greece
| | - Konstantina Kalopita
- Department of Anaesthesiology and Pain Medicine, "Elena Venizelou" General Hospital of Athens, Athens, Greece
| | - Spyridoula Theodorou
- Department of Obstetrics/Gynecology, "Elena Venizelou" General Hospital of Athens, Athens, Greece
| | - Konstantinos Stroumpoulis
- Department of Anaesthesiology and Pain Medicine, "Elena Venizelou" General Hospital of Athens, Athens, Greece
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Ergani SY, Orgul G, Tolunay HE, Arici M, Yucel A, Uygur D. Gitelman Syndrome in Pregnancy: A Clinical Challenge. Z Geburtshilfe Neonatol 2021; 225:526-528. [PMID: 34126642 DOI: 10.1055/a-1498-2940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Disease progress may be affected by pregnancy-related changes, and underlying conditions may also affekt pregnancy outcomes in women with Gitelman syndrome (GS). Case presentation A 35-year-old woman with GS (gravida 2 para 1) was referred to our hospital to start routine antenatal care follow-up at 6 weeks of gestation. At the age of 31, she had been diagnosed with GS after her first uneventful pregnancy. Upon early admission, her serum Mg+level was 0.51 mmol/L and her serum K+level 2.7 mmol/L with normal kidney function tests. She was already taking oral combined potassium citrate and potassium bicarbonate supplementation once a day before pregnancy. At the eighth gestational week, the medication was changed to an oral potassium color sachet of 1.5 gram per day until labor because of the insufficient dosage to maintain optimum potassium levels. She was also taking 365 milligrams of oral magnesium oxide twice a day before and during pregnancy. In the third trimester of the pregnancy, her serum Mg+level was 0.48 mmol/L and serum K+level 2.8 mmol/L. Because of the previous uterine surgery history, she underwent an elective cesarean operation at 39 weeks' gestation under spinal anesthesia and delivered a healthy 3090-gram female infant. CONCLUSION Increased need for potassium and magnesium supplementation should be the critical considerations when managing pregnant patients with GS.
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Affiliation(s)
- Seval Yilmaz Ergani
- Perinatology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe Universitesi Tip Fakultesi, Altindag, Turkey
| | - Harun Egemen Tolunay
- Perinatology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Mustafa Arici
- Division of Nephrology, Department of Internal Medicine, Hacettepe Universitesi Tip Fakultesi, Altindag, Turkey
| | - Aykan Yucel
- Perinatology, Ankara City Hospital, Cankaya, Turkey
| | - Dilek Uygur
- Perinatology, Ankara City Hospital, Cankaya, Turkey
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Rombach S, Benner A, Schick MA. [Sectio Caesarea under Gitelman Syndrome]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:289-295. [PMID: 33890260 DOI: 10.1055/a-1299-0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gitelman syndrome is a rare inherited renal tubulopathy characterized by hypokalemia, hypomagnesemia and metabolic alcalosis. It is caused by a mutation in the SLC12A3 gene leading to a dysfunction of the thiazide-sensitive sodium chloride cotransporter and the magnesium transporters in the distal convoluted tubules. Only few reports of pregnant woman with Gitelman syndrome exist. Due to many unsolved questions about the impact on pregnancy and the maternal and fetal outcome, the obstetric and anesthesiological management remains a challenge. We discuss the case of a primary cesarean delivery in a 22-year-old woman with a new diagnosed Gitelman syndrome focusing on the anesthesiological approach.
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Affiliation(s)
- Stephan Rombach
- Department of Anesthesiology and Critical Care Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Benner
- Department of Anesthesiology and Critical Care Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Alexander Schick
- Department of Anesthesiology and Critical Care Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract
OBJECTIVE To evaluate maternal and fetal outcomes in women with Gitelman syndrome (GS). METHODS Retrospective analysis of the clinical data of five patients with the clinical diagnosis of GS during pregnancy, who were admitted to Beijing Shijitan Hospital, Capital Medical University between 2013 and 2019, was conducted. RESULTS Five women with GS during pregnancy who finally gave birth to a total of eight newborns have been included. Three cases were primiparas and two cases were multiparas. Two cases were diagnosed before pregnancy and three cases were diagnosed in first or second trimester. The primary treatment was oral or intravenous electrolytes supplement. Three patients delivered through the vagina, and shoulder dystocia occurred in one patient. Two patients delivered by cesarean section, with one because of symptom of limb weakness during the course of labor and the other owing to gestational diabetes with fetal macrosomia. Postpartum hemorrhage and urinary retention were not reported in these cases. In perinatal period all the infants had good outcome. The children, aged between six months and five years, were healthy and well-developed during follow-up. CONCLUSION The maternal and perinatal outcome is usually favorable. We should pay attention to electrolyte examination in the first trimester in order to diagnose and manage the GS efficiently. Well-controlled patients with Gitelman syndrome can deliver through the vagina.
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Affiliation(s)
- Jingfei Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Feiran Liu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jinghui Tu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Venugopalan S, Puthenveettil N, Rajan S, Paul J. Anaesthesia for emergency caesarean section in a patient with Gitelman syndrome. Indian J Anaesth 2020; 64:524-526. [PMID: 32792720 PMCID: PMC7398015 DOI: 10.4103/ija.ija_40_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/06/2020] [Accepted: 04/18/2020] [Indexed: 12/18/2022] Open
Abstract
Gitelman syndrome is a rare autosomal recessive salt-losing disorder of renal tubules, which results in hypokalemic metabolic alkalosis. Associated hypomagnesaemia and hypocalcaemia are also seen. Gitelman syndrome is a variant of renal Bartter's syndrome. Anaesthetic management of these obstetric patients is challenging and requires a careful multidisciplinary approach. Close monitoring of potassium and magnesium levels and their supplementation is required to avoid complications to mother and baby.
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Affiliation(s)
- Sarath Venugopalan
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Nitu Puthenveettil
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jerry Paul
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Wu WF, Pan M. The outcome of two pregnancies in a patient with Gitelman syndrome: case report and review of the literature. J Matern Fetal Neonatal Med 2019; 33:4171-4173. [PMID: 30922139 DOI: 10.1080/14767058.2019.1598359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of a 30-year-old woman who was first found to have a persistently low serum potassium level at 26 years of age during her first pregnancy. Genetic test of SLC12A3 confirmed Gitelman syndrome. The patient remained asymptomatic and had two deliveries following spontaneous labor. The first neonate died of heart failure due to cardiac abnormalities. The obstetric and neonatal outcome of the second pregnancy was good.
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Affiliation(s)
- Wei-Fang Wu
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mian Pan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Gitelman Syndrome: A Rare Cause of Seizure Disorder and a Systematic Review. Case Rep Med 2019; 2019:4204907. [PMID: 30867665 PMCID: PMC6379858 DOI: 10.1155/2019/4204907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/20/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023] Open
Abstract
Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.
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Elbouajaji K, Blanchier D, Pourrat O, Sarreau M. [Management of Gitelman syndrome during pregnancy reporting 12 cases]. Nephrol Ther 2018; 14:536-543. [PMID: 30309814 DOI: 10.1016/j.nephro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/08/2018] [Accepted: 06/24/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Gitelman syndrome is a rare hereditary renal tubulopathy, responsable of hypokalemia and hypomagnesaemia-related ionic disorders, which management is poorly codified during pregnancy. We report 12 cases of pregnancies with Gitelman syndrome and we compare our data with those of literature. MATERIAL AND METHODS It is a report of 12 pregnancies in 5 patients with Gitelman syndrome between 2002 and 2016. Follow up and outcome of pregnancy, delivery modalities and maternal-fetal prognosis have been collected. RESULTS In our serie, maximum kaliemie observed was 3.4mmol/L, with an average potassium, over all pregnancies of 2.3mmol/L. Oral potassium and magnesium supplementation at the end of pregnancy were 8900mg/day and 460mg/day, respectively. There were no serious maternal complications. Two pregnancies were complicated by intrauterine growth retardation in a context of preeclampsia. There is a large disparity in the methods of anesthetic management of these patients. Materno-fetal prognosis at 1 month post-partum is good. CONCLUSION Gitelman syndrome is a rare pathology where there is a lack of homogeneity in management of pregnancy. Monitoring of monthly ionogram is necessary. The goal is to obtain stable, non-symptomatic kaliemias, which will never be standardized even in increasing treatment. The most important is to inform and detect situations at risk of decompensation, including vomiting or the use of certain anesthetics. In agreement with literature data, monitoring of fetal growth and the amount of amniotic fluid in the third trimester is still warranted. These pregnancies require the development of a common care in multidisciplinary consultation meeting.
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Affiliation(s)
- Karima Elbouajaji
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Dominique Blanchier
- Service de néphrologie, CH d'Angoulême, Rond-point de Girac, 16000 Angoulême, France
| | - Olivier Pourrat
- Service de réanimation médicale, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Mélie Sarreau
- Service de gynécologie obstétrique, CH d'Angoulême, Rond-point de Girac, 16000 Angoulême, France.
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Gallagher H, Soar J, Tomson C. New guideline for perioperative management of people with inherited salt-wasting alkaloses. Br J Anaesth 2018; 116:746-9. [PMID: 27199308 DOI: 10.1093/bja/aew102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- H Gallagher
- South West Thames Renal Unit, Epsom and St Helier NHS Trust, Carshalton, UK
| | - J Soar
- Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - C Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Two cases of successful pregnancy in patients with Gitelman's syndrome. Clin Nephrol 2018; 84:301-6. [PMID: 26109196 PMCID: PMC4776256 DOI: 10.5414/cn108526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 12/28/2022] Open
Abstract
Gitelman's syndrome (GS) is a distal convoluted tubule (DCT) defect clinically characterized by hypokalemic metabolic alkalosis. Pregnancy in women with GS often results in severe hypomagnesemia and hypokalemia. We report two cases of successful pregnancies, after previous fetal loss, in patients with GS managed with aggressive oral and intravenous electrolyte repletion. These cases illustrate increased potassium and magnesium requirements over the course of the pregnancies and are notable due to the high doses of electrolytes required. They also demonstrate the possibility of successful pregnancy outcomes with frequent laboratory monitoring and aggressive titration of electrolyte replacement either orally or intravenously to maintain appropriate serum levels necessary to provide a suitable environment for fetal development.
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Mathen S, Venning M, Gillham J. Outpatient management of Gitelman's syndrome in pregnancy. BMJ Case Rep 2013; 2013:bcr-2012-007927. [PMID: 23355577 DOI: 10.1136/bcr-2012-007927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gitelman's syndrome is a congenital renal tubular defect which affects the apical membrane of the distal convoluted tubule of the renal system. The syndrome is characterised by hypokalaemia, hypomagnesaemia, metabolic alkalosis and hypocalcuria. There are only a few cases describing the impact of Gitelman's syndrome on pregnancy and the foetus. Although most pregnancies have favourable outcomes, fetal demise has been reported in the third trimester. We report the successful outcome of pregnancy in a patient with Gitelman's syndrome who continued on amiloride in pregnancy to optimise potassium and magnesium levels and review the literature for pregnancy outcomes of this condition.
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Affiliation(s)
- Stephy Mathen
- Department of Obstetrics and Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.
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12
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Moustakakis MN, Bockorny M. Gitelman syndrome and pregnancy. Clin Kidney J 2012; 5:552-5. [PMID: 26064481 PMCID: PMC4400552 DOI: 10.1093/ckj/sfs126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 08/09/2012] [Indexed: 11/14/2022] Open
Abstract
Gitelman syndrome (GS) is an autosomal-recessive condition characterized by hypokalemia, hypomagnesemia and hypocalciuria. Very little information is available in the literature to guide the management of pregnant patients with GS. We report a case of a 27-year-old woman with GS who became pregnant and despite persistent hypokalemia and hypomagnesemia during pregnancy and labor, had a successful maternal and fetal outcome.
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Raffi F, Fairlie FM, Madhuvrata P, Bennet WM. Pregnancy with Gitelman's syndrome. Obstet Med 2011; 4:39-41. [PMID: 27579097 DOI: 10.1258/om.2010.100046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2010] [Indexed: 11/18/2022] Open
Abstract
Gitelman's syndrome is a rare genetic disease associated with chronic hypokalaemia, hypomagnesaemia and hypocalciuria. It requires lifelong supplementation with potassium and magnesium. Pregnancy management can be difficult and there are few published reports. Our case adds to the literature and illustrates some of the potential problems.
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Affiliation(s)
- F Raffi
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
| | - F M Fairlie
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
| | - P Madhuvrata
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
| | - W M Bennet
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
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