Hyperemesis Gravidarum in Undiagnosed Gitelman’s Syndrome

Acelajado, Maria Czarina; Culpepper, R. Michael; Bolton, Wilburn D.

doi:10.1155/2016/2407607

Cited by 4 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The concentration of (K + ) in the serum is a balance among intake, excretion, and distribution between the extra-and intracellular spaces (32) . A patient with Hyperemesis gravidarum (HG) frequently vomits gastric juice and, thus, the loss of hydrogen ions, sodium, chloride, and water in gastric contents leads to chloride-sensitive metabolic alkalosis, dehydration, and extracellular fluid (ECF) volume reduction (33) causing elevated activity of the renin-angiotensin-aldosterone system (RAAS) (33) . This activated RAAS, in turn, increases the urinary excretion of potassium, compounding the hypokalaemia (34) .…”

Section: Discussionmentioning

confidence: 99%

The Effect of Vitamin D3, Vitamin B6, Selenium and Some Electrolytes on the Women with Nausea and Vomiting of Pregnancy in Thi-Qar Government -Iraq

2020

MLU

View full text Add to dashboard Cite

Objective: Nausea and vomiting (NVP) are among the most common symptoms during pregnancy. NVP causes emotional and psychological distress and can have a profound impact on a woman's quality of life (QoL).Material and Method: Vitamin D3 and Vitamin B6,se and electrolytes (Mg +2 ,K + ) levels were determined in first and second trimesters in 120 women suffering from nausea and vomiting of pregnancy,30 pregnant women free of symptoms, age identical between the ages of (17-45) years.Results: Vitamin D3 Vitamin B6, K + , Se and Mg +2 in the blood showed a significant decrease in all patients as compared to control group (P ≤ 0.05). Conclusion:In patients with NVP and NP we find a significant reduction in level of Vit.D3, and decrease in level of serum Vit. B6,K + , Se and Mg +2 . In first trimester found a decrease in levels of Vit.D3, Vit.B6 and K + more from second trimester,while in first trimester found an increase in levels Se, Mg +2 more from second trimester.

show abstract

Section: Discussionmentioning

confidence: 99%

The Effect of Vitamin D3, Vitamin B6, Selenium and Some Electrolytes on the Women with Nausea and Vomiting of Pregnancy in Thi-Qar Government -Iraq

2020

MLU

View full text Add to dashboard Cite

show abstract

“…A case of maternal cardiac arrest second to profound hypokalaemia in a patient with HG presents a unique opportunity to discuss the potential implications of this common disorder. A patient with HG frequently vomits gastric juice and, thus, the loss of hydrogen ions, sodium, chloride, and water in gastric contents leads to chloride-sensitive metabolic alkalosis, dehydration, and extracellular fluid (ECF) volume reduction [ 5 ]. Our patient had lost approximately 9% in body weight and likely was volume deplete, causing elevated activity of the renin-angiotensin-aldosterone system (RAAS) [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…A patient with HG frequently vomits gastric juice and, thus, the loss of hydrogen ions, sodium, chloride, and water in gastric contents leads to chloride-sensitive metabolic alkalosis, dehydration, and extracellular fluid (ECF) volume reduction [ 5 ]. Our patient had lost approximately 9% in body weight and likely was volume deplete, causing elevated activity of the renin-angiotensin-aldosterone system (RAAS) [ 5 ]. This activated RAAS, in turn, increases the urinary excretion of potassium, compounding the hypokalaemia [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other rare differential diagnoses include a tubulointerstitial disorder resulting in excessive renal potassium wasting. One example of such a disorder is Gitelman's syndrome [ 5 ]. This is extremely unlikely given that she had normal urinary electrolytes with no evidence of sodium or potassium wasting outside of pregnancy and no personal or family history to suggest this [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

Walch

Duke

Auty

et al. 2018

Case Reports in Obstetrics and Gynecology

View full text Add to dashboard Cite

We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks' gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission. Despite these complications, she was discharged home 4 weeks later with a full recovery. Following a plethora of inpatient and outpatient investigations, the cause of her cardiac arrest was determined to be profound hypokalaemia. The hypokalaemia was presumed second to a perfect storm of HG with subsequent nutritional deficiencies causing electrolyte wasting, extracellular fluid (ECF) volume reduction, and activation of the renin-angiotensin-aldosterone axis (RAAS). This combined with the physiological changes that promote potassium wasting in pregnancy including volume expansion, increased renal blood flow, increased glomerular filtration rate, and increase in cortisol contributed to the patient having a profoundly low total body potassium level. This diagnosis is further strengthened by the fact that her pre- and post-pregnancy potassium levels were within normal limits in the absence of supplementary potassium. This case highlights the potentially life-threatening electrolyte imbalances that can occur with HG and the importance of recognising the disease, comprehensive electrolyte monitoring, and aggressive management in pregnancy.

show abstract

“…Potassium homeostasis typically remains normal in pregnancy despite multiple physiologic changes that promote renal potassium wasting: volume expansion, increased renal blood flow, increased glomerular filtration rate (GFR), elevation of cortisol levels and activation of the renin-angiotensin-aldosterone (RAS) axis. Serum potassium levels are maintained at physiologic levels by increased levels of progesterone, which resist kaliuresis [5]. This compensatory mechanism can be easily overwhelmed by maternal conditions such as gastrointestinal disorders, alcoholism, malnutrition, diabetes mellitus, and tubulointerstitial disorders and can lead to maternal hypokalemia.…”

mentioning

confidence: 99%

Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus

et al. 2019

View full text Add to dashboard Cite

Although hyperemesis gravidarum (HG), an extreme form of morning sickness, is a common complication during pregnancy, HG associated simultaneous onset of rhabdomyolysis and diabetes insipidus due to electrolyte abnormalities are rare. A 34-year-old woman with severe HG at 17 weeks of gestation complicated with appetite loss, weight reduction by 17 kg, general fatigue, myalgia, weakness and polyuria was identified to have simultaneous hypophosphatemia (1.6 mg/dL) and hypokalemia (2.0 mEq/L). Appetite recovery and the improvement of the hypophosphatemia (3.2 mg/dL) were observed prior to the first visit to our department. At the admission, she presented polyuria around 7,000~8,000 mL/day with impaired concentrating activity (U-Osm 185 mOsm/L), and abnormal creatine kinase elevation (4,505 U/L). The electrolyte disturbances and physio-metabolic abnormalities in undernourished state due to HG let us diagnose this case as refeeding syndrome (RFS). In this case, abnormal loss by vomiting, insufficient intake and previous inappropriate fluid infusion as well as the development of RFS may accelerate the severity of hypokalemia due to HG. Thus, as her abnormalities were considered as results of rhabdomyolysis and diabetes insipidus due to severe HG associated hypokalemia based on RFS, oral supplementation of potassium chloride was initiated. After 6 days of potassium supplementation, her symptoms and biochemical abnormalities were completely resolved. Severe HG followed by RFS can be causes of electrolyte abnormalities and subsequent complications, including rhabdomyolysis and renal diabetes insipidus. Appropriate diagnosis and prompt interventions including adequate nutrition are necessary to prevent electrolyte imbalance induced cardiac, neuromuscular and/or renal complications.

show abstract

Hyperemesis Gravidarum in Undiagnosed Gitelman’s Syndrome

Cited by 4 publications

References 16 publications

The Effect of Vitamin D3, Vitamin B6, Selenium and Some Electrolytes on the Women with Nausea and Vomiting of Pregnancy in Thi-Qar Government -Iraq

The Effect of Vitamin D3, Vitamin B6, Selenium and Some Electrolytes on the Women with Nausea and Vomiting of Pregnancy in Thi-Qar Government -Iraq

Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus

Contact Info

Product

Resources

About