1. [Surreptitious intake of diuretics as the cause of pseudo-Bartter's syndrome: apropos of a case and differential diagnosis].
- Author
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Olveira Fuster G, Mancha Doblas I, Vázquez San Miguel F, Esteva de Antonio I, and C-Soriaguer Escofet F
- Subjects
- Adult, Chlorthalidone adverse effects, Chlorthalidone blood, Chlorthalidone urine, Chromatography, High Pressure Liquid, Diagnosis, Differential, Diuretics adverse effects, Diuretics blood, Diuretics urine, Female, Furosemide adverse effects, Furosemide urine, Humans, Hypokalemia chemically induced, Bartter Syndrome diagnosis, Diuretics administration & dosage, Factitious Disorders, Hypokalemia diagnosis, Self Medication
- Abstract
We describe a 39 years old patient with a history of chronic symptomatic hypokalemia. She denied taking any drugs. She satisfied the clinical criteria for Bartter's syndrome and more precisely for Gitelman's syndrome: hypokalemia in the presence of inappropriately high potassium excretion, metabolic alkalosis, hyperreninemic hyperaldosteronism, hypomagnesemia with inappropriately high magnesium excretion, normocalcemia, hypocalciuria and normal blood pressure. A HPLC analysis detected the presence of furosemide in urine and chlorthalidone in urine and plasma samples. After the self administration of diuretics was stopped, the above alterations came back to normality. Prior to the verification of a self administration of diuretics, the patient showed clinical and biochemical parameters that oriented to surreptitious diuretic ingestion (Pseudo-Bartter's syndrome) not to Bartter's syndrome or Gitelman's syndrome, particularly the plasma potassium readily restored to normal by the administration of potassium chloride supplements, the increased plasma uric acid with low uric acid fractional clearance, the widely different urine and plasma electrolyte levels and the presence psychiatric disorders. The literature is reviewed and differential diagnosis, among this three syndromes, is made.
- Published
- 1996