title: Surreptitious habitual vomiting simulating Bartter's syndrome.
abstract: A patient with hypokalemic alkalosis, normotensive hyperreninism, hyperaldosteronism, increased levels of urinary and plasma prostaglandin E, and vascular hyporesponsivity to angiotensin II was thought to have Bartter's syndrome. Results of a kidney biopsy showed hyperplasia of the juxtaglomerular apparatus but no renomedullary cell hyperplasia. A 24-hour urine collection showed a low chloride level and no increase in the fractional chloride clearance, thus excluding Bartter's syndrome. Subsequent disclosure of surreptitious, habitual vomiting explained the hypokalemia.
mesh_terms: D000328:Adult; D000804:Angiotensin II / Q000494:pharmacology; D001477:Bartter Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D002712:Chlorides / Q000652:urine; D003937:Diagnosis, Differential; D003971:Diastole / Q000187:drug effects; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis*; D007008:Hypokalemia / Q000209:etiology*; D011188:Potassium / Q000652:urine; D011189:Potassium Chloride / Q000008:administration & dosage; D014839:Vomiting / Q000150:complications* / Q000523:psychology
chemical_list: D002712:Chlorides; D000804:Angiotensin II; D011189:Potassium Chloride; D011188:Potassium