Gitelman-Like Syndrome Secondary to Occupational Solvent Inhalation

Introduction: Gitelman’s syndrome is a renal tubulopathy characterized by hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria, due to distal tubular salt wasting. Symptoms include muscle cramps, paresthesias, nocturia, salt craving, weakness, and fatigue. It is caused by biallelic mutations in the SLC12A3 gene, which encodes the thiazide-sensitive NCC transporter. Non-genetic mimics include diuretic use, chronic laxative abuse, prolonged vomiting, certain medications, autoimmune diseases, and pregnancy but not solvent exposure. Case Description: A 62-year-old male patient with hypertension and a history of chronic solvent exposure due to his professional roles as a tinsmith and a painter was admitted to the hospital with complaints including upper limb muscle contractions, paresthesias, and bradycardia (57 beats per minute). Laboratory investigations revealed the presence of chlorine-insensitive metabolic alkalosis, renal-origin hypokalemia, hypomagnesemia, hypocalcemia, neutrophilic leukocytosis, and thrombocytosis. Despite exhaustive investigative efforts, no identifiable infectious source was identified. Consequently, CT scans revealed gastric wall thickening. The findings were attributed to solvent inhalation. Following a period of treatment, the patient was discharged on a medication regimen consisting of telmisartan, spironolactone, potassium, magnesium sulfate, and aspirin. The patient demonstrated notable improvement during their follow up. Discussion: Inhaled solvents can cause various kidney issues, but Gitelman-like syndrome has not been previously reported. This patient had high blood pressure, which is unusual for Gitelman’s syndrome, typically linked to low blood pressure. Elevated white blood cells and platelets were considered reactive. Treatment focused on correcting fluid and electrolyte imbalances, with potassium normalized over 10 days and supplements given. Though genetic testing and renin levels couldn't be measured, the findings indicated a Gitelman-like syndrome caused by solvent inhalation.