Two cases of successful pregnancy in patients with Gitelman's syndrome

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.

Figure 1.. Magnesium supplementation (depicted by the bar graph) and corresponding week during pregnancy (dose in mEq is given above each bar). Serum magnesium levels (depicted by the line graph) and corresponding week during pregnancy. Downward arrow indicates patient 1’s transition from oral to intravenous supplementation.

Figure 2. Potassium supplementation (depicted by the bar graph) and corresponding week during pregnancy (dose in mEq is given above each bar). Serum potassium levels (depicted by the line graph) and corresponding week during pregnancy. Downward arrow indicates patient 1’s transition from oral to intravenous supplementation.