Abstract: SA-PO999

12 Years of Intraperitoneal Magnesium Infusions for Gitelman Patient with Normal GFR

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Khan, Nasir, Yale University School of Medicine, New Haven, Connecticut, United States
  • Geller, David, Yale University School of Medicine, New Haven, Connecticut, United States
  • Bia, Margaret J., Yale University, Guilford, Connecticut, United States
Background

Gitelman’s Syndrome is an autosomal recessive salt-wasting renal tubular disorder characterized by hypokalemic metabolic alkalosis with hypomagnesemia that can be potentially life threatening. We report a case of Gitelman's Syndrome with use of peritoneal infusions in the setting of preserved renal function to manage these severe electrolyte complications.

Methods

A 57-year-old Caucasian female with longstanding history of muscle weakness and twitching, paresthesias and palpitations manifested at the time of her pregnancy at age 24 years when she was found to have severe hypomagnesemia and hypokalemia. She was presumptively diagnosed with Gitelman’s Syndrome, a diagnosis confirmed genetically years later. She did not tolerate oral magnesium(Mg) replenishment due to severe gastrointestinal side effects. Intramuscular Mg replenishment was also attempted but this was complicated by recurrent boils at injection sites. She was diagnosed with idiopathic cardiomyopathy and heart block, both attributed to her electrolyte derangements, and a permanent pacemaker was placed. A Hickman catheter was placed to allow parenteral electrolyte repletion, but this led to multiple bouts of septicemia over a period of several years, caused by gram-positive, gram-negative and fungal infections. In addition she had several pacemaker lead changes, resorting to epicardial leads at times to avoid transvenous leads. Given her significant disease burden and electrolyte derangements, a peritoneal catheter was placed to attempt intraperitoneal(IP) infusion as a method to replenish Mg and potassium(K). Although she did not tolerate intraperitoneal K infusions (abdominal pain), she has now infused IP Mg for 12 years with relatively few complications and a significant improvement in her health and quality of life.

Conclusion

Gitelman’s Syndrome is a hereditary cause of potentially severe hypokalemia and hypomagnesemia. Management of these electrolyte complications is challenging, and patients often suffer significant morbidity from both the electrolyte derangements and the efforts to control these derangements. We describe the successful use of IP infusions to manage a particularly challenging case of hypomagnesemia. We believe the unique characteristics of the peritoneal membrane make this modality an excellent option in patients in whom parenteral electrolyte repletion is considered necessary.