A Case of Outpatient Hysterectomy in the Setting of Gitelman Syndrome

Gitelman syndrome is a rare autosomal recessive disorder involving a defect in the sodium-chloride cotransporter, which is expressed in the apical membrane of the distal convoluted tubule. Electrolyte abnormalities commonly occur in patients with Gitelman syndrome as a result, including hypokalaemia, hypomagnesemia, and metabolic alkalosis. As a result, the disorder may present with various clinical manifestations, including fatigue, weakness, muscle tetany, facial paresthesias, and a predisposition to the development of various ventricular arrhythmias. As a result, the perioperative management of patients with this disorder presents unique challenges with regard to fluid and electrolyte management and the prevention and management of potential arrhythmias. In addition, the pharmacology of various anesthetics may present additional complexity with regard to perioperative management in this particular patient population. The following case presentation of a 42-year-old female with Gitelman syndrome undergoing elective outpatient hysterectomy for suspected endometriosis serves to illustrate the challenges that arise with regard to perioperative management in this particular patient population and demonstrates how they may be addressed.