Abstract: SA-PO0613
Home Parenteral Support in Refractory Gitelman Syndrome: Renal and Vascular Consequences of Long-Term Intravenous Therapy
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 2
October 24, 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
- Fahal, Fayez, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, England, United Kingdom
- Silva, Janaka Manilal, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, England, United Kingdom
- Samad, Nasreen, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, England, United Kingdom
- Fahal, Ibrahim Hassan, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, England, United Kingdom
Introduction
Gitelman syndrome (GS) is a rare autosomal recessive tubulopathy characterised by hypokalaemia, hypomagnesaemia, metabolic alkalosis, and hypocalciuria. Management is usually oral; long-term intravenous electrolyte replacement is uncommon.
Case Description
A 65-year-old woman with severe, refractory GS presented at age 46 with weakness and dizziness, one year after diagnosis. Comorbidities included Type 2 Diabetes Mellitus and hypertension. Despite maximal oral therapy (high-dose potassium chloride 28 tablets/day, magnesium, spironolactone, and amiloride), she remained persistently hypokalaemic and hypomagnesaemic. She has required home parenteral support (HPS) for >16 years and remains actively dependent on parenteral therapy, receiving multiple overnight infusions of electrolyte replacement over 14-hour (80 mmol potassium, 40 mmol magnesium) via a tunnelled Hickman line, and oral supplementation. A service reorganisation in 2023, care transitioned to a multidisciplinary intestinal failure unit, where HPS was consolidated into a single bespoke 12-hour overnight infusion without reducing total electrolyte delivery, reducing treatment burden, catheter manipulation, and sleep disruption.
Discussion
This case highlights significant renal and vascular burden associated with severe, refractory Gitelman syndrome requiring long-term parenteral therapy. Prolonged central venous access resulted in substantial morbidity, including recurrent catheter-related bloodstream infections (CRBSIs), multiple line exchanges, and catheter-related venous thromboses (CRVTs). These complications led to repeated sepsis-associated acute kidney injury, cumulative nephron loss, and progressive chronic kidney disease.
Despite optimisation of therapy, renal function declined to CKD G3A1, reflecting the cumulative impact of metabolic instability and recurrent haemodynamic insults. Concurrently, progressive vascular injury culminated in central venous occlusion, significantly limiting future access and underscoring the loss of “venous capital.”
Importantly, rationalisation of parenteral therapy into a single overnight infusion reduced catheter manipulation and was associated with a sustained two-year infection-free period. This case underscores the importance of minimising catheter exposure and adopting proactive vascular preservation strategies to mitigate long-term renal and vascular complications.