Bartter syndrome-like phenotype in a patient with diabetes: a case report

Abstract

BackgroundBartter’s syndrome is a rare genetic tubulopathy affecting the loop of Henle leading to salt wasting. It is commonly seen in utero or in early neonatal period. Rare cases of acquired Bartter’s syndrome are reported in association with infections like tuberculosis, granulomatous conditions like sarcoidosis, autoimmune diseases, and drugs. The mainstay of management includes potassium, calcium, and magnesium supplementation.Case presentationWe report the case of a 62-year-old Sri Lankan Sinhalese man with diabetes and hypertension presenting with generalized weakness with clinical evidence of proximal myopathy. He was severely hypokalemic with high urinary potassium excretion and hypochloremic metabolic alkalosis. He poorly responded to intravenously administered potassium supplements. A diagnosis of idiopathic Bartter-like phenotype was made. He responded well to spironolactone and indomethacin.ConclusionsPatients presenting with body weakness need serum potassium estimation. Acquired Bartter’s syndrome although rare, should be ruled out in those with hypokalemia and metabolic alkalosis with increased urinary potassium loss with poor response to potassium replacement.

A Novel Mutation in Cystic Fibrosis Presenting as Pseudo Bartter Syndrome: A Case Report

“…The patient has normal or low blood pressure. Acquired BS or pseudo BS is very rare but is reported in tuberculosis, Sjogren's disease, Sarcoidosis, or may be drug-induced in intake of aminoglycosides, Loop diuretics, and amphotericin B among other [6]. Our patient presented with metabolic alkalosis, low BP and high plasma aldosterone and renin level and responded well to injectable KCl and spironolactone favouring a diagnosis of BS.…”

Acquired autoimmune Bartter syndrome in a patient with primary hypothyroidism

“…He was treated aggressively with IV potassium replacement, but it remained < 3 meq with significant renal loss. He maintained low normal potassium concentration on oral potassium supplement, Indomethacin, and Spironolactone therapy [11]. The addition of spironolactone marginally improved potassium, but the level was still subnormal.…”

“…This patient presented with a one-month history of neuromuscular weakness, which revealed a low plasma potassium concentration. Arterial blood gas analysis was consistent with severe metabolic alkalosis [11]. He was treated aggressively with IV potassium replacement, but it remained < 3 meq with significant renal loss.…”

“…Another report mentions the concurrence of Bartter syndrome in a 62-year-old Sri Lankan man patient with Type 2 Diabetes Mellitus (DM) [11]. This patient presented with a one-month history of neuromuscular weakness, which revealed a low plasma potassium concentration.…”

“…This was similar to our patient in that she also responded to Indomethacin. Notably, the patient wasn't commenced on steroids due to underlying poorly controlled DM [11].…”