Hyperemesis Gravidarum in Undiagnosed Gitelman’s Syndrome

Table 1

Laboratory work-up. Summary of important laboratory tests performed during the patient’s hospitalization. On day 6 of hospitalization, the calculated transtubular potassium gradient (TTKG) is 30.77, consistent with renal potassium wasting.

Parameter	On admission	6th hospital day	After amiloride 5 mg/day	After amiloride 10 mg/day	At the time of delivery
Creatinine (umol/L)	63.6	38.9	47.7	38	50.3
Blood urea nitrogen (mmol/L)	5	1.43	5.71	5	4.29
Potassium (mmol/L)	2.3	2.6	2.6 to 3.3	2.8 to 3.5	3
Sodium (mmol/L)	137	134	135	132	137
Magnesium (mmol/L)	0.45	0.45	0.58 to 0.74	0.58 to 0.82	0.62
Calcium (mmol/L)	2.33	2.2	2.33	2.33	2.15
HCO3 (mmol/L)	32	33	26	29	26
Chloride (mmol/L)	93	95	96	99	99
Serum osmolality (mOsm/kg)	—	286	—	—	—
Urine osmolality (mOsm/kg)	—	379	—	—	—
Spot urine chloride (mmol/L)	—	239	—	—	—
Spot urine sodium (mmol/L)	—	178	—	—	—
Spot urine creatinine (umol/L)	—	3978	—	—	—
Spot urine potassium (mmol/L)	—	106	—	—	—
pH	—	7.51	—	—	—
pCO2 (mm Hg)	—	41	—	—	—