Pseudo-Bartter's syndrome, diuretic abuse, idiopathic edema, and eating disorders

Abstract

Literature concerning Bartter's syndrome, pseudo‐Bartter's syndrome, idiopathic edema, and diuretic abuse is reviewed. The authors suggest that many of the patients who present with the physiological disturbances associated with pseudo‐Bartter's syndrome or with diuretic abuse, and a subgroup of those who use diuretics for idiopathic edema, have an underlying eating disorder. The pharmacology and physiology of diuretics are reviewed.

Effective medical treatment strategies to help cessation of purging behaviors

“…This use of a diuretic would seem counterintuitive for a patient population who, as a result of purging behaviors, has chronic volume depletion. Moreover, in patients with bulimia nervosa, there are reports of actual abuse of diuretics in up to 33% of the population . Indeed, there are three classes of prescription diuretics, but only one should in general be considered in the treatment of Pseudo‐Bartter syndrome; that diuretic is spironolactone.…”

What the emergency department needs to know when caring for your patients with eating disorders

“…11 These metabolic abnormalities can lead to very nonspecific complaints such as dizziness, fatigue, palpitations, muscle spasms, seizures, and cardiac dysrhythmias. The self-induced vomiting and diuretic abuse seen in bulimia leads to a chronic state of dehydration (contraction alkalosis), which activates the kidney's rennin-angiotensin-aldosterone system, leading to an increase in the absorption of sodium and bicarbonate at the expense of potassium and hydrogen.…”

Eating disorders

“…Behaviors such as vomiting and diuretic abuse may be exacerbated as the patient reacts psychologically to the edema. 6,28 Hypophosphatemia may occur in anorectics as a result of poor dietary intake. It can also be a dangerous complication of refeeding.…”