Table 5: Treatment of Gitelman syndrome.
• Increased NaCl intake, diet rich in K+ and Mg2+ • Oral potassium supplementation (mainly KCl; > 40 mEq/d with meals; target: serum potassium > 3 mEq/L • In severe symptomatic cases intravenous KCl should be carefully administered in hypotonic saline solutions (< 50 mmol/L at a rate of < 10 ml/h) • Oral magnesium supplementation (mainly organic salts, such as aspartate, citrate, lactate or MgCl2; 300 mg/d (12.24 mmol/L) in 2-4 doses (osmotic diarrhea is a common adverse effect); target: serum magnesium > 0.6 mmol/l • In severe symptomatic cases intravenous infusion of MgCl2 or MgSO4 is suggested • Potassium sparing diuretics, such as spironolactone, eplerenone (50 mg × 2/d) or amiloride (up to 20 mg/d); special care to avoid natriuresis and hypotension is mandatory • Other drugs like renin angiotensin system blockers; however increased natriuresis associated with hypotension is a common side effect • Non-steroidal anti-inflammatory drugs or COX-2 inhibitors; however long term adverse effects limit their long-term administration |