[Surreptitious intake of diuretics as the cause of pseudo-Bartter's syndrome: apropos of a case and differential diagnosis].
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.
Olveira Fuster
G
G
Sección de Endocrinología, Hospital Regional, Málaga.
Mancha Doblas
I
I
Vázquez San Miguel
F
F
Esteva de Antonio
I
I
C-Soriaguer Escofet
F
F
D000328:Adult; D001477:Bartter Syndrome / Q000175:diagnosis*; D002752:Chlorthalidone / Q000009:adverse effects / Q000097:blood / Q000652:urine; D002851:Chromatography, High Pressure Liquid; D003937:Diagnosis, Differential; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000652:urine; D005162:Factitious Disorders; D005260:Female; D005665:Furosemide / Q000009:adverse effects / Q000652:urine; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced / Q000175:diagnosis*; D012651:Self Medication
D004232:Diuretics; D005665:Furosemide; D002752:Chlorthalidone