Gitelman’s Syndrome: Hypokalæmia
Report:
Sinus rhythm 85/min
Right axis deviation +140o
Right bundle branch block
Large TU waves c/w hypokalæmia
Comment:
This is, almost, a P-on-U phenomenon (no pun intended), as Schamroth put it11. The diagnosis can only be made, as reported, in a context of known hypokalæmia (1.4 mEq/L at the time of the recording). Otherwise, long QT interval or “cerebral” TU waves are a possibility. There is no clear separation of T and U waves in any lead. Indeed, the QTc may itself be prolonged here, because of the associated hypomagnesæmia.
A later trace, with potassium of 2.0 mEq/L, is shown below. The U waves are now separate, but not particularly striking. ECG is a poor tool here and there is no substitute for actual electrolyte measurements.
Gitelman’s is a variant of Bartter’s syndrome12.
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