Quadriparesis in an adult--Gitelman syndrome

A 24 years old soldier presented with sudden onset of weakness in all four limbs. There was no history of any antecedent respiratory infection, fever, diarrhoea or vomiting. Neurological examination of limbs revealed reduced tone and power in all limbs. Although the tendon reflexes were diminished they could be elicited in all limbs. Rest of the clinical examination was unremarkable. Serum potassium was 2.1 mmol/l, sodium 138 mmol/l, bicarbonate 35.3 mmol/l, urea 5.7 mmol/l, creatinine 69 umol/l and serum creatine kinase (CK) was 686 U/l. Power in the patient's limbs gradually improved to normal by following afternoon after potassium chloride infusion. Serum chloride was 93 mmol/l, bicarbonate 33.4 mmol/l, calcium 2.1 mmol/l, urine sodium 134 mmol/l, urine potassium 82 mmol/l, urine chloride 156 mmol/l and urine pH 6.0. Urinary calcium excretion was 2.2 mmol in 24 hours. Serum magnesium was 0.7 mmol/l. A diagnosis of Gitelman syndrome was made. He is doing well on spironolactone, potassium chloride supplementation and high sodium diet, maintaining serum potassium level between 3.5 and 4.5 mmol/l.