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Gitelman-like Syndrome with Kanamycin Toxicity.

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Multi-drug-resistant tuberculosis (MDR-TB) requires complex treatment regimens.
  • Aminoglycosides like Kanamycin are used in MDR-TB but can cause toxicity.
  • Electrolyte imbalances are potential side effects of various medications.

Observation:

  • A young female patient with MDR-TB developed muscle cramps and carpopedal spasm.
  • Investigations revealed significant hypokalemia, metabolic alkalosis, hypomagnesemia, hypochloremia, and hypocalciuria.
  • Renal function tests (serum urea and creatinine) were within normal limits.

Findings:

  • The patient's symptoms and biochemical abnormalities mimicked Gitelman's syndrome.
  • Discontinuation of Kanamycin and potassium supplementation led to gradual improvement over one month.
  • The observed Gitelman-like syndrome was attributed to Kanamycin toxicity, a previously unreported association.

Implications:

  • Kanamycin toxicity should be considered in patients with MDR-TB presenting with unexplained electrolyte disturbances.
  • This case highlights a novel presentation of drug-induced Gitelman-like syndrome.
  • Awareness of this adverse effect can guide timely diagnosis and management in similar clinical scenarios.