Journal of the American Society of Nephrology Essay
Topic 3 DQ 2 Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style. I chose Gitelman\’s syndrome Gitelman\’s syndrome is a genetic disorder of the SLC12A3 gene that primarily leads to the reabsorption of urinary salt back into the bloodstream (NIH, 2020). The SLC12A3 gene that triggers the several circumstances of Gitelman syndrome produces a protein called thiazide-sensitive NaCl cotransporter (NCC) that aids in the transportation of salts across the kidney\’s ion pathways (NORD, 2018). The mutation causes an irregular activity of the NCC protein, which carries electrolytes across the ion pathways, resulting in wastage of water and salt that leads to volume reduction. As the transportation of electrolytes is disrupted, the mismatch of the body\’s main electrolytes leads to symptoms related to the imbalance. This condition does not occur until late childhood and probably into puberty. Journal of the American Society of Nephrology Essay. It is a recessive autosomal gene and, signs and symptoms can differ significantly between affected individuals, even those of the same family. Signs and symptoms of this condition are closely linked to the disease it causes. Signs and symptoms of Gitelman Syndrome typically occur in late childhood or puberty. Specific characteristics of this disorder include tetany, muscle fatigue or cramping, drowsiness, and salt craving. Many typical signs involve a tingling or prickling feeling in the skin, most commonly involving the neck. Any persons with Gitelman syndrome undergo excessive fatigue, hypotension, and a debilitating joint condition called chondrocalcinosis (NIH, 2020). Consideration should also be provided to life-threatening heart riffs caused by a lack of critical electrolytes such as magnesium, potassium, and calcium. Unfortunately, there is no solution to this disease, and the recovery relies on the management of pain. Joint measures would be needed across a variety of disciplines (nephrology, car, etc.). Genetic tests will be suggested in families with this disorder. Education can play a vital role in the management of these people. A cohesive family / patient-centered solution is required. Education topics should include the symptoms of electrolyte deficiency, appropriate administration of medicines, and the pharmacological management of pain (NORD, 2018) Journal of the American Society of Nephrology Essay.
Topic 3 DQ 2
Potassium or Magnesium Supplementation in the Treatment of Gitelman Syndrome
Gitelman Syndrome occurs due to defect in sodium-chloride cotransporter and thus intake of NaCl is the mainstream treatment. In patients with hypomagnesemia, the first-line treatment is magnesium supplementation since repletion magnesium activates the repletion of potassium; this lowers the risk of complications such as tetany (Blanchard et al., 2017).
Potassium supplements are supposed to be administered as chloride (KCl) since the key anion that is lost in the urine is chloride. In order to reduce the risk of GIT irritation or damage, patients should not take potassium supplements on an empty stomach. The potassium dose is titrated upwards depending on the tolerance and efficacy (Blanchard et al., 2017). Patients should also be encouraged to take foods rich in potassium. The target for potassium level is 3.0 mmol/l. Generally, potassium supplementation increases serum potassium concentration. For patients who cannot take potassium supplements orally or during severe potassium deficit, intravenous KCl may be the alternative route of administration (Blanchard et al., 2015).
Magnesium supplements are used to correct the deficiency of magnesium. Magnesium supplements heighten hypokalemia and therefore it is a refractory treatment through potassium. All kinds of magnesium salts have shown efficacy in the treatment of magnesium deficiency (Zhong et al., 2019). The starting dose of magnesium for adults is 300 mg/day while for children is 5 mg/kg. Magnesium supplementation is supposed to be divided into 2-4 doses to avoid diarrhea associated with magnesium, which may aggravate hypokalemia as well as symptoms of volume reduction (Robinson & Frankl, 2017). Magnesium supplements should be taken with meals. Titration of the dose should be based on intestinal tolerance and blood levels. Magnesium can be administered intravenously if the patient presents with severe hypomagnesemia complications such as cardiac arrhythmias or tetany (Robinson & Frankl, 2017).
Side effects associated with potassium or magnesium supplementation include diarrhea, gastric ulcers, abdominal pain, vomiting, and deteriorating biochemistries. If the patient experiences persistent diarrhea, the dose should be reduced (Zhong et al., 2019).
It is important to closely monitor plasma electrolyte levels in patients taking magnesium and potassium supplements and also closely monitor for any side effect. Generally, the treatment goal of Gitelman Syndrome should be the improvement of symptoms and not normalizing the electrolyte abnormalities (Zhong et al., 2019). Journal of the American Society of Nephrology Essay.
Blanchard, A., Bockenhauer, D., Bolignano, D., Calo, L. A., Cosyns, E., Devuyst, O., … & Lin, S. H. (2017). Gitelman syndrome: consensus and guidance from a kidney disease: improving global outcomes (KDIGO) controversies conference. Kidney International, 91(1), 24-33.
Blanchard, A., Vargas-Poussou, R., Vallet, M., Caumont-Prim, A., Allard, J., Desport, E., Dubourg, L., Monge, M., Bergerot, D., Baron, S., Essig, M., Bridoux, F., Tack, I., & Azizi, M. (2015). Indomethacin, amiloride, or eplerenone for treating hypokalemia in Gitelman syndrome. Journal of the American Society of Nephrology: JASN, 26(2), 468–475. https://doi.org/10.1681/ASN.2014030293.
Robinson, C. M., & Frankl, F. E. (2017). Magnesium lactate in the treatment of Gitelman syndrome: patient-reported outcomes. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association – European Renal Association, 32(3), 508–512. https://doi.org/10.1093/ndt/gfw019.
Zhong, F., Ying, H., Jia, W., Zhou, X., Zhang, H., Guan, Q., … & Xu, C. (2019). Characteristics and Follow-Up of 13 pedigrees with Gitelman syndrome. Journal of endocrinological investigation, 42(6), 653-665. Journal of the American Society of Nephrology Essay.