Recent rapid responses
Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers' letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.
Displaying 1-4 out of 4 published
27 September 2012
My GP told me about this article and on his suggestion I looked it up online. I am a Gitelman patient and my current GP is incredibly supportive and helpful about handling my condition. I really value his understanding.
I had immense trouble in my 20's and 30's, with severe stomach cramps, very dry skin and almost permanent constipation, unaware that this was caused by low potassium. The consultants I saw at the time acuused me of eating liquorice or, probably because I am female, taking diuretics in order to lose weight. I was disagnosed with Bartter's Syndrome but given nothing for it.
It is only in the last five years that I have been properly treated. I returned to the renal unit and thanks to a wonderfully knowledgeable consultant was diagnosed with Gitelman and now take tablets and supplements. I am stable most of the time but do need to take the medication on a very regular basis.
I, too, ate huge amounts of salt as a child and still do; always preferring salty foods and disliking sweet things and hating sport! My nightmare scenario is a bout of gastric flu!! That is tough, but I always know when things are going downhill and can take action. I am so grateful for a terrific GP.
Competing interests: None declared
None, London SW1V
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+14 August 2012
So pleased to see this article! Being a Doctor with Gitelman's, I have experienced many of the problems this patient mentions.
If not the GP, it will be the pharmacist, asking me why I am on two types of Potassium sparing diuretics, AND potassium supplements and am I totally 100% sure that I am meant to take all three?!
I also ate crisps/salty items as a child and I continue to eat salt like a woman possessed! My colleagues are slowly getting used to it, although I still get some funny looks when I empty 3 salt sachets onto my lunch!
It is also nice to see that people are recognising the need for patients to be experts in their condition and to carry instruction letters/information regarding their condition and management. I have had some very bad experiences in the Emergency department when medical staff would not give me IV Mg+ and IV K+, resulting in paralysis and very painful tetany.
I now carry letter headed paper as the article suggests, with strict instructions on what to put in the IV bags, and what my condition is.
Once again, it's really nice to see this disease (which is becoming more common) be mentioned and recognised =)
Competing interests: None declared
James Paget University Hospital, JPUH hospital, Great Yarmouth.
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+7 August 2012
I read with interest the difficulties in establishing the diagnosis of Gitelman syndrome. The other important aspect to mention is the difficulty often encountered in optimising the near normal serum magnesium levels, and often the large oral magnesium supplements are counterintutive and frequently result in gastrointestinal side effects including diarrhea.
Although, factors controlling magnesium absorption are not well understood and as oral magnesium is poorly absorbed and, in large doses, causes gastrointestinal side effects [1]. Replacement by the oral route is not practicle and often difficult in majority of symptomatic patients with hypomagnesemia. Studies have shown a saturable component of magnesium absoprtion whereby intestinal absorption of magnesium is inversely related to intake; 65% at low intake and 11% at high intake [2]. The intestinal brush border only absorbs a small fraction of the oral dose at a given time and the remaining part of the large oral supplements frequently ends up in the large intestines, where it causes gastrointestinal side effects. Hence, in patients with magnesium deficiency of any cause, including in patients with Gitelman’s syndrome, where large doses of magnesium supplementation are often required, it is important to give small and frequent doses than large but infrequent doses of oral magnesium supplements to optimize near normal serum magnesium levels without causing gastrointestinal side effects.
1. Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev. 2003 May; 24(2): 47–66. PMID:1855626
2. Kayne LH, Lee DB. Intestinal magnesium absorption. Miner Electrolyte Metab. 1993;19:210–217 PMID: 8264506
Competing interests: None declared
Northern Ontario School of Medicine, 640 Ross Ave. East, Timmins, ON P4N 8P2
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+30 May 2012
Thank you for sharing your journey with us. Your story is humbling and I hope that we can provide a better service to you in the future.
Do you think that if you had electronic access to your record, it would have got round this problem? perhaps also another idea for improving the journey would be to flag this up at the new patient registration when you start at a new practice.
Perhaps another thing that may be useful would be if you had an individualised pathway on www.mapofmedicine.com. This could be agreed between your current consultant and your GP. As a GP i often use this to help me in cases where I am not sure what the next best plan of action is. If we could combine the two it would improve your subsequent care, so that if you ever had to move to another practice it would be less traumatic to you.
Competing interests: None declared
Care UK, Ealing Urgent Care centre
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