Tetania severa por uso de enemas fosfatados, reporte de caso / Tetany secondary to phosphate enema toxicity, case report

Los enemas fosfatados son utilizados frecuentemente en el tratamiento de la constipación. Errores en la posología pueden producir complicaciones graves. Objetivo: Reportar un caso de toxicidad grave por enema fosfatado en un pre escolar sin factores de riesgo. Caso clínico: Paciente de 2 años con constipación funcional, evaluada en servicio de urgencia por dolor abdominal a quién se le diagnosticó un fecaloma impactado. Recibió 2 dosis de enema de fosfato, “medio frasco” de Fleet® adulto (Synthon, Chile) por vez, sin resolución de su fecaloma, decidiéndose hospitalización para proctoclisis. Posterior al ingreso presentó un cuadro clínico de tetania. Ingresó a la Unidad de Paciente Crítico donde se confirmó una hiperfosfemia e hipocalcemia secundaria. Se realizó corrección electrolítica progresiva, retiro de enema fosfatado residual del recto e hiperhidratación forzando diuresis. La tetania cedió 2 horas después del ingreso sin otras complicaciones. Se realizó proctoclisis y fue dada de alta a los 3 días. Conclusión: Los enemas fosfatados pueden presentar complicaciones graves en niños sin factores de riesgo. Errores en la posología son la causa más frecuente de toxicidad en este grupo, pero esta puede estar favorecida también por una administración y eliminación inadecuadas. Pediatras y personal de salud que atiende a niños deben conocer factores de riesgo, signos y síntomas de intoxicación por enemas fosfatados.

Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage and administration can lead to severe complications. Objective: To report a case of severe toxicity of phosphate enemas in a child with no risk factors. Case: 2 years old female, with functional constipation, was brought to emergency department because abdominal pain. She was diagnosed with fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times, with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission, she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2 hours after admission and no other complications. Proctoclisis was performed and patient was discharged three days after admission with pharmacological management of constipation. Conclusion: Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage, administration and removal of the enema are causes of toxicity in this group. Pediatricians and health personnel must be aware of risks and signs of toxicity of phosphate enema.

A Case of GNAS1 Mutation in Pseudohypoparathyroidism Type Ia

Pseudohypoparathyroidism (PHP) is a group of genetic disorders in which the kidneys fail to respond to parathyroid hormone. Genetic defects in the GNAS complex locus lead to reduced Gsalpha (alpha-subunit of the heterotrimeric stimulatory G protein) activity in PHP type Ia patients. These patients exhibit characteristics of Albright hereditary osteodystrophy (AHO) and hypocalcemia, increased parathyroid hormone, and resistance to other Gsalpha protein-coupled hormones. AHO has a wide range of manifestations such as short stature, obesity, round face, subcutaneous ossification, and bone shortening in the hands and feet. In this study, we present the case of a 47-yr-old woman who was diagnosed with PHP type Ia with AHO. She showed tetany, dizziness, irritability to light, decreased visual acuity, cognitive impairment, and motor dysfunction. Direct sequencing identified a heterozygous missense mutation in exon 6 (c.466G>A, p.Asp156Asn) in GNAS1. To our knowledge, this case is the first report in Korea of PHP type Ia caused by a heterozygous missense mutation in exon 6 (c.466G>A, p.Asp156Asn) in GNAS1.

Clinical and laboratory characteristics of neonatal hypocalcemia

PURPOSE: To describe the clinical characteristics of full-term neonates with hypocalcemia and to suggest factors associated with neonatal hypocalcemia METHODS: The medical records of full-term neonates with hypocalcemia were reviewed. Hypocalcemia was defined as an ionized calcium (iCa) concentration of <4 mg/dL. Parathyroid hormone (PTH) insufficiency was defined as a serum PTH level of <60 pg/mL or a serum phosphorus level higher than the serum calcium level in the presence of hypocalcemia. RESULTS: Fifty-three neonates were enrolled. The median age at diagnosis of hypocalcemia was 3 days. In all the neonates, formula feeding predominance was observed. Thirty-eight neonates (69.8%) were compatible with PTH insufficiency. The number of formula-fed neonates was significantly higher than that of breast-fed patients among neonates with PTH insufficiency (P=0.017). Intact PTH was negatively correlated with serum phosphorus levels. Twelve out of 14 neonates (85.7%) had 25-hydroxy vitamin D (25OHD) levels <20 ng/mL and 9 neonates (64.3%) had 25OHD levels <10 ng/mL. Twenty-one neonates had hypocalcemic tetany. The serum calcium and iCa concentrations of neonates with tetany were 4.2-8.3 mg/dL and 1.85-3.88 mg/dL, respectively. Three neonates showed symptomatic hypocalcemia with calcium levels over 7.5 mg/dL. Among the 16 neonates who underwent electroencephalography (EEG), 12 had abnormalities, which normalized after 1-2 months. CONCLUSION: Formula milk feeding, PTH insufficiency and low serum vitamin D concentration are associated with the development of neonatal hypocalcemia. Symptoms such as tetany and QT interval prolongation can develop in relatively mild hypocalcemia. Moreover, transient neonatal hypocalcemia can cause transient EEG abnormalities.

A Case of Acute Suppurative Thyroiditis Complicated by Hypocalcemia / 대한내과학회지

We report a case of acute suppurative thyroiditis complicated by idiopathic hypoparathyroidism. The patient was a 49-year-old female who visited our clinic with a painful goiter on the left lobe of the thyroid gland. She was hypocalcemic, which was accompanied unusually by acute suppurative thyroiditis. She also suffered from tetany of both hands and legs. She had undergone a right subtotal thyroidectomy at another hospital 23 years previously due to a benign thyroid nodule. Intact parathyroid hormone (PTH) levels were increased, but other laboratory findings were normal. No special treatment was administered for the acute suppurative thyroiditis, except antibiotics, to observe its natural course. Her PTH levels decreased and serum calcium returned to normal. The complication of acute suppurative thyroiditis suggested the possible involvement of idiopathic hypoparathyroidism.

Adrenaline improves endurance of rabbit gastrocnemius: a study with continuous high frequency stimulation

Beta adrenoceptor agonists are well known for their potentiating effects on peak twitch and tetanic tension and defatiguing effects on skeletal muscles. Adrenaline [ADR] is one of these agonist which is known for inotropism but less described for fatigue. In addition, studies on high frequency stimulation [HFS] of skeletal muscles are scarce and not available for tetanization fatigue related with endurance and recovery under the influence of ADR. We hypothesized that ADR can maintain peak tetanic tension [PTT] produced by mammalian skeletal muscles for longer period as well as help in recovery from fatigue on continuous HFS. Gastrocnemius muscles [medial Belly] from both limbs were isolated from Rabbits [Oryctologus cunniculus] and continuously stimulated at High frequency of 80Hz for 20Sec. Tetanic tensions were recorded digitally with the measurement of PTT at different time points during this stimulation. Time [T[50]] was also noted at which muscle force was reduced to 50%. At 20Sec of continuous stimulation, mean PTT[% of initial] was declined significantly in both the ADR treated and control CTL muscles being greater in CTL ones. T[50] was found 74.9% greater in ADR than CTL, being significant. When muscles, which were fatigued with same stimulation protocol, were allowed to recover with and without adrenaline, the PTT recovers by 3.4 folds in ADR and about 2 folds only in CTL. Significant differences between CTL and ADR treated-continuously stimulated high frequency fatigued muscles confirm the hypothesis that in mammalian muscles ADR increases the endurance by delaying the high frequency fatigue and helps in its recovery

Gitelman syndrome combined with complete growth hormone deficiency

Gitelman syndrome is a rare autosomal recessive hereditary salt-losing tubulopathy, that manifests as hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. It is caused by mutations in the solute carrier family 12(sodium/chloride transporters), member 3 (SLC12A3) gene encoding the thiazide-sensitive sodium chloride cotransporter channel (NCCT) in the distal convoluted tubule of the kidney. It is associated with muscle weakness, cramps, tetany, vomiting, diarrhea, abdominal pain, and growth retardation. The incidence of growth retardation, the exact cause of which is unknown, is lower than that of Bartter syndrome. Herein, we discuss the case of an overweight 12.9-year-old girl of short stature presenting with hypokalemic metabolic alkalosis. The patient, on the basis of detection of a heterozygous mutation in the SLC12A3 gene and poor growth hormone (GH) responses in two provocative tests, was diagnosed with Gitelman syndrome combined with complete GH deficiency. GH treatment accompanied by magnesium oxide and potassium replacement was associated with a good clinical response.

A Case of Parathyroid Apoplexy of Primary Hyperparathyroidism Presenting as Auditory Hallucinations Accompanied with Hypocalcemia

The natural history of primary hyperparathyroidism, due to parathyroid adenoma, is unknown. Furthermore, spontaneous resolution of parathyroid necrosis or hemorrhage is rare and usually asymptomatic. Here, we report a case of parathyroid apoplexy of primary hyperparathyroidism, presenting as auditory hallucinations, accompanied with hypocalcemia. A 39-year-old man who was incidentally diagnosed with primary hyperparathyroidism, and waiting surgery for parathyroidectomy presented to psychiatric service with auditory hallucinations. He developed tetany, while taking psychiatric drugs. On a follow-up investigation, his serum calcium level fell from 11.8 to 5.8 mg/dL. His intact parathyroid hormone level also decreased from 1,017 pg/mL to 71.1 pg/mL. The parathyroid apoplexy was confirmed after a surgical removal of the infarcted adenoma. The auditory hallucinations disappeared, and serum calcium level was returned to within the normal range.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia / Análisis de costo-efectividad de la administración postoperatoria de Vitamina D y calcio después de tiroidectomía para la prevención de la hipo calcemia

Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Objetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce la incidencia de hipocalcémia sintomática. Se evalúa su costo-efectividad en Colombia. Materiales y métodos Utilizamos la información de un meta-análisis que comparó la administración de vitamina D o metabolitos contra calcio no tratamiento en pacientes llevados a tiroidectomía total y diseñamos un análisis de costo-efectividad basados en un modelos de decisiones con costos locales. Resultados El valor del OR para la comparación entre calcitriol y calcio comparado con no tratamiento o calcio exclusivo fue de 0.32 (95 % IC, 0.13- 0.79) y 0.31 (95 % IC, 0.14-0.70), respectivamente. La estrategia más costo-efectiva fue la administración de vitamina D o metabolitos y calcio, con una relación de costo-efectividad incremental de US $0.05. Conclusiones El tratamiento profiláctico de la hipo calcemia con vitamina D o metabolitos y calcio o calcio exclusivo después de tiroidectomía total es una estrategia costo-efectiva.

Tetany: Possible adverse effect of bevacizumab.

Background: Bevacizumab a recombinant humanized monoclonal antibody was approved in 2004 by US FDA for metastatic colorectal cancer. It is reported to cause potentially serious toxicities including severe hypertension, proteinuria, and congestive heart failure. Aim: To correlate adverse event tetany with the use of bevacizumab. Materials and Methods : World Health Organization's Uppsala Monitoring Centre, Sweden, for reporting of adverse drug reactions from all over the world, identified 7 cases with tetany-related symptoms to bevacizumab from four different countries. These 7 patients reported to UMC database developed adverse events described as musculoskeletal stiffness (1), muscle spasm (1), muscle cramps (1), lock jaw or jaw stiffness (4), and hypertonia (1), with hypocalcaemia. Results: After detailed study of the possible mechanism of actions of bevacizumab and factors causing tetany, it is proposed that there is a possibility of tetany by bevacizumab, which may occur by interfering with calcium metabolism. Resorption of bone through osteoclasts by affecting VEGF may interfere with calcium metabolism. Another possibility of tetany may be due to associated hypomagnesaemia, hypokalemia, or hyponatremia. Conclusions: Tetany should be considered as a one of the signs. Patient on bevacizumab should carefully watch for tetany-related symptoms and calcium and magnesium levels for their safety.

Revisión histórica de la fisiología de las glándulas paratiroides / Historical review of the physiology of parathyroid glands

Las glándulas paratiroides fueron identificadas por primera vez en humanos, por Ivan Sãndstrom (1880). Von Recklinghausen en 1891 describe un "linfonódulo marrón rojizo" bajo la tiroides de un paciente con fibrosis quística ósea. Ese mismo año Gley asocio la pérdida en la función de las paratiroides con la tetania. Vassale y Generali publicaron un trabajo en 1897 realizado tras tiroidectomías en perros y concluyen que una de las funciones de las paratiroides era la remoción de toxinas, concordando con la "teoría de detoxificación". G. Moussu (1898) clamó haber tratado satisfactoriamente a un paciente con tetania administrándole extracto acuoso de paratiroides equinas. En 1903 Askanazy establece que los tumores de la glándula tiroides u otras glándulas endocrinas y afecciones descalcificantes esqueléticas podrían relacionarse al describir el primer caso de asociación entre un tumor paratiroideo y la enfermedad de Von Recklinghausen. MacCallum y Voegtlin (1924), tras numerosos estudios, dedujeron que la paratiroides actuaba como moduladora del metabolismo del calcio. Collip (1925) confirmó el rol protagónico de las paratiroides en la regulación del calcio mediante experimentos basados en que la "paratirina" podía aliviar la tetania post-paratiroidectomía Barnicot en 1948 concluye que la hormona paratiroidea estimula la resorción osteoclásica de forma directa; ese nismo año, Jahan y Pitts demostraron que esta hormona incrementa la reabsorción renal tubular de calcio y magnesio. En 1973, Aurbach purifica cierta cantidad de hormona paratiroidea, caracterizándose su estructura proteica y molecular. La clonación de su receptor por Jüppner y Abou-Samra (1991) permitió estudiar con mayor énfasis sus acciones celulares.

Parathyroid glands were identified by the first time in human beings by Ivan Sãndstrom (1880). Von Recklinghausen in 1891 describes "lymph node reddish brown" low thyroid of patients with fibrosis cystic in bones. The same year Gley associated the loss in the function of the parathyroids with tetania. Vassale and Generali published a review in 1897 realized after thyroidectomies in dogs and they concluded that one of the parathyroid functions was the renoval of toxins, agreeing with "theory of detoxification". G. Moussu (1898) cried out to have treated satisfactorily a patient with tetania administering watery extract of equine parathyroids. In 1903 Askanazy establishes that the tumors of the thyroid gland or other endocrines glands and decalcifying affections of the skeleton might be related on having described the first case of association between a parathyroid tumor and Von Recklinghausen's disease. Mac callum and Voegtlin (1924), alter numerous studies, deduced that parathyroid was actuating like modulating of the metabolism of the calcium. Collip (1925) confirmed the leading role of the parathyroid glands in the regulation of calcium by means of experiments based on which the "parathyrina" could relieve the postparathyroidectomy tetania. Barnicot in 1948 concludes that the parathyroid hormone stimulates the osteoclastic resorption directly, the same year, Jahan and Pitts demonstrated that this hormone increases the renal tubular reabsorption of calcium and magnesium. In 1973, Aurbach purifies certain quatity of parathyroid hormone, its multifaceted and molecular structure being characterized. The cloning of its receptor for Jüppner and Abou-Samra(1991) allowed to study with bigger emphasis its cellular actions.

Hypocalcemic Tetany in a 13-Year-Old Girl with Wilson's Disease / 대한소아소화기영양학회지

Wilson's disease is an autosomal recessive disorder marked by disruptions in copper metabolism which leads to accumulation of copper in the liver, brain, cornea, and other tissues. Manifestations of this disease are more likely to be hepatic during early childhood and neurologic in adolescent. In addition, abnormalities that develop during disease progression may result in other manifestations such as hematologic, endocrine, or renal findings. Here we report a 13-year-old girl who presented with hypocalcemic tetany shortly after being diagnosed with Wilson's disease. Despite aggressive calcium, magnesium, and vitamin D replacement therapy, the hypocalcemia and hypomagnesemia did not promptly respond. Mineral levels in the blood took longer than 3 weeks to normalize. We speculate that a parathyroid insufficiency and disrupted vitamin D metabolism caused by copper accumulation and hepatic dysfunction resulted in hypocalcemic tetany.

Dilated Cardiomyopathy in a 2 Month-Old Infant: A Severe Form of Hypocalcemia With Vitamin D Deficient Rickets

Dilated cardiomyopathy, which mostly has an idiopathic etiology or is caused by genetic inheritance or infection, can cause irreversible congestive heart failure. Hypocalcemia is a rare etiology of reversible dilated cardiomyopathy. Here we report the case of a two-month-old girl with congestive heart failure who was diagnosed as having dilated cardiomyopathy secondary to hypocalcemia. After calcium and vitamin D replacement therapy, the patient showed a rapid reduction in hypocalcemic tetany and a rapid recovery of left ventricular function. The cause of the hypocalcemia was vitamin D deficient rickets. She was exclusively breast-fed as an infant, and her mother had a vitamin D deficiency and was diagnosed with osteomalacia.

Control de la tetania en modelos quirúrgicos de hipocalcemia en ratas / Management of tetany in hypocalcemic models in the rat

La remodelación ósea es un proceso bajo el control de un complejo mecanismo que involucra factores endócrinos, autócrinos y parácrinos. La hipocalcemia tiene en parte el control de la remodelación ósea por modificación de los niveles de parathormona (PTH). La disminución de la acción de PTH produce un estado de baja remodelación ósea. La disminución de la función paratiroidea se puede lograr en la rata por ablación simultánea de tiroides y paratiroides (tiroparatiroidectomía: TPTX) o por ablación de las glándulas paratiroideas (paratiroidectomía: PX). TPTX es una cirugía de baja complejidad y requiere administración posterior de hormonas tiroideas en agua de bebida. PX requiere más entrenamiento pero no la administración de tiroxina. En ambos casos la hipocalcemia es el signo indicador del éxito de la ablación, cuyo valor es cercano o inferior a 7.5 mg/dl. La búsqueda de modelos de hipocalcemia para obtener estados de baja remodelación ósea ha demostrado que la tetania asociada a la hipocalcemia es la complicación más importante en el mantenimiento de los animales y la realización de cirugías posteriores. Se realizaron cirugías de PX, TPTX y ablación de una de las dos glándulas paratiroideas (1/2PX). Los resultados hallados indican que la PX y 1/2PX producen hipocalcemia más severa que TPTX y la 1/2PX produce un modelo de hipocalcemia muy severa pero transitoria. La administración de gluconato de calcio en agua de bebida evita la presencia de tetania durante el mantenimiento de los animales, pero no durante cirugías con anestesia general. La administración de gluconato de calcio intramuscular evita la tetania que se produce como consecuencia de la anestesia general.

Idiopathic hypoparathyroidism: A rare cause of reversible heart failure / 대한내과학회지

A 65-year-old woman presented with acute pulmonary edema, generalized tetany, and paresthesia. She had severe hypocalcemia, a low intact parathyroid hormone level, and her echocardiogram revealed left ventricular dysfunction. She had no history of heart failure or thyroid surgery. The heart failure improved after calcium replacement and conventional heart failure management. She was diagnosed with hypocalcemia-induced heart failure caused by idiopathic hypoparathyroidism. Despite the crucial role of calcium in myocardial contractility, hypocalcemia is rarely reported as a cause of heart failure. In conclusion, plasma calcium should be measured in the initial workup of all patients with heart failure, and corrected if hypocalcemia is seen. Idiopathic hypoparathyroidism is a rare cause of reversible heart failure that should be considered in the etiologic assessment.

Tetany in kala azar patients treated with paromomycin.

Paromomycin, an aminoglycoside, is known to cause several side effects like nephrotoxicity and ototoxicity like other aminoglycosides but tetany has not been reported. Three cases of tetany were detected in the patients of kala-azar treated with paromomycin. They were promptly treated with intravenous 10 per cent calcium gluconate and tetany was relieved immediately and treatment with paromomycin continued with oral calcium supplement. After completion of 21 days treatment with paromomycin patients' splenic aspirates were free of parasites. Paromomycin may cause temporary tubular damage leading to calcium wasting in urine and hypocalcaemia resulting in tetany. Prompt detection of symptoms and intravenous calcium gluconate treatment promptly reverse the situation.

Aplicacion de la vacuna antitetanica durante el embarazo como prevencion del tetanos neonatal en el area de Kami durante el primer trimestre de 2007 / Implementation of the Tetanus vaccine during pregnancy prevention neonatal Tetanus in the area of Kami during the first quarter of 2007

De un total de poblacion encuestada de 107, encontramos que el 91 por ciento de mujeres ambarazadas que asisten a su control prenatal no fueron vacunadas con toxoide tetanico. En cuanto a las causas por las que las mujeres entrevistadas refirieron no haber sido vacunadas la resaltan la falta de informacion (acerca de la enfermedad y beneficios de la vacuna para ellas y los recien nacidos) y la distancia de su hogar al centro de salud. Existiendo en menor proporcion los aspectos culturales (el rechazo a la medicina moderna o creencias equivocas acerca de las vacunas y el embarazo), y el temor a los efectos secundarios

relationship of hypocalcemic convulsions related to nutritional rickets with age, gender, season, and serum phosphorus levels

To retrospectively evaluate the epidemic characteristics of children with hypocalcemic convulsion related to nutritional rickets in the province of Kars, Turkey. In this study, clinical and laboratory findings of 93 infants, aged between 1-24 months, who were diagnosed as hypocalcemic convulsive resulting from nutritional rickets between January 2000 and June 2005 in Kars Maternity and Child Hospital, were investigated. The data of the cases with hypocalcemic convulsive rickets were collected from the hospital archive file. The mean and median ages of the cases were 8.93 and 6 [1-24] months, and 66 [71%] were male. Most of the patients were admitted to hospital in February and March, whereas 46% were admitted in winter, 44% in spring, 8% in autumn, and 2% in summertime. Serum calcium levels of all cases were low [mean: 5.4 +/- 0.84 mg/dl] and serum alkaline phosphate levels were high [mean: 1286 +/- 528 IU/L], while serum phosphorus levels were low in 19 [20.4%], high in 8 [8.6%], and normal in 66 [71%] patients. While evaluating the causes of convulsion, hypocalcemic convulsion related to nutritional rickets should be considered among the causes as well as age, gender, and season of the year, and diagnosis, and treatment should be initiated without delay. In addition, serum phosphorus level should also be questioned in the diagnosis of nutritional rickets

Cobertura de vacunacion antitetanica en mujeres en edad fertil y embarazadas de 15-49 años (Estudio aproximativo realizado en la 1ª seccion del Municipio de Quillacollo 2005 / Tetanus vaccination coverage among women of childbearing age and pregnant women aged 15-49 years (approximate study conducted in the 1st section of the Municipality of Quillacollo 2005

Del total de 368 mujeres de 15-49 años 69 por ciento recibio la vacuna, un 19 por ciento de mujeres no y un 12 por ciento que no sabe; probablemente esto se deba a la falta de concientizacion sobre la importancia de la vacunacion. En la distribucion de la vacunacion por rango de edad en mujeres de 15 a 20 años el porcentaje es alto de 58 por ciento que no saben si fueron vacunadas a comparacion de los datos obtenidos de las mujeres de 21-30 años con un 42 por ciento, ya que esta poblacion se encuentra en una edad fértil y estan mas informadas sobre la necesidad y los beneficios de la vacunacion. La prueba de chi-cuadrado da un resultado de dependencia P-Value=0,0

A Case of Gitelman's Syndrome Presented with Chest Pain and Syncope / 대한신장학회잡지

Gitelman's syndrome is a rare autosomal recessive, inherited renal tubular disorder, first described by Gitelman et al. in 1966, and it is characterized by hypokalemic metabolic alkalosis, hypomagnesemia, salt wasting, normal to low blood pressure and rather low urinary calcium excretion rates with elevated plasma renin activity. This syndrome is caused by inactivating mutation in the SLC12A3 gene coding for the thiazide-sensitive sodium chloride cotransporter in the distal convoluted tubule. In most of the patients with Gitelman's syndrome, the disease manifests with transient episodes of muscular weakness and tetany in the adulthood. Herein, we report a case of Gitelman's syndrome atypically presented with chest pain and syncope.