Abstract: FR-PO0909
When Electrolytes Seize: Neurologic Manifestations of Gitelman Syndrome - Seizure or Tetany?
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Hernandez Gomez, Martha Jazmin, Unidad de Medicina Familiar No 2, Guadalajara, Jalisco, Mexico
- Ruiz Fabian, Linda Giovanna, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Figueroa Rodríguez, Isaacs José, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Rodríguez Ramírez, Nadyeli Zolian, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Bonilla Otero, Ivana, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Maldonado, Ana M., Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Olivo Torres, Shelsie T., Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Giron Licardie, Mynor Jose Pablo, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Paez Morales, Emily, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Rivera, Daniel Alejandro, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Ortiz Barajas, Laisa Michelle, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Ahmad, Kashif A., Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Alvarez, Lucia E., Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Aranda, Andres, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
Group or Team Name
- Nephrology Interest Group School of Medicine UAG
Introduction
Gitelman syndrome is an inherited salt-losing tubulopathy characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. Although often identified during evaluation of chronic electrolyte abnormalities, severe neurologic manifestations are uncommon and may delay diagnosis.
Case Description
A 27-year-old woman initially presented with gastroenteritis and was found to have hyperglycemia and hypokalemia, attributed to gastrointestinal losses. She was discharged with outpatient follow-up.
One year later, she developed non-severe dengue infection with vomiting, diarrhea, fever, and myalgias, worsening her underlying electrolyte imbalance, followed by a generalized abnormal motor event initially classified as “convulsive.” Neuroimaging was unremarkable. Laboratory studies revealed recurrent hypokalemia, hypomagnesemia, and hypocalcemia requiring intravenous replacement, initially attributed to acute illness. In retrospect, the episode raised concern for electrolyte-mediated tetany versus seizure.
During follow-up, she was diagnosed with type 2 diabetes mellitus, transaminitis with elevated ALT, AST, and GGT, and bilateral simple renal cysts. Persistent electrolyte abnormalities prompted nephrology referral. Further evaluation demonstrated metabolic alkalosis, urinary chloride >61 mmol/L, low ionized calcium, inappropriately normal parathyroid hormone, and hypocalciuria with fractional excretion of calcium <0.01, consistent with Gitelman syndrome.
Treatment included amiloride, oral magnesium (1600 mg/day), calcium, vitamin D, and iSGLT2 to leverage their reported magnesium-raising effect. Despite therapy, hypomagnesemia and hypokalemia persist, with improved calcium levels. Genetic evaluation for HNF1B is pending.
Discussion
This case highlights gastrointestinal losses as a trigger for worsening electrolyte derangements and unmasking previously undiagnosed Gitelman syndrome. Severe electrolyte-mediated neurologic manifestations, including tetany versus seizure, may represent an uncommon presenting feature. Earlier recognition may prevent delayed diagnosis and recurrent decompensation.