A case of pseudo‐Bartter's syndrome due to intestinal malrotation

Abstract

Intestinal malrotation presenting beyond the neonatal period is associated with a multiplicity of symptoms, which are often non‐specific and, consequently, are associated with delays in diagnosis. Pseudo‐Bartter's syndrome, which mimics the manifestations of Bartter's syndrome, can be caused by a severe chloride deficiency secondary to vomiting, diarrhea, perspiration, diuretic abuse and so on. We describe a 6 year old boy who had been admitted to hospital three times during the preceding year. The patient lapsed into a critical condition with profound hypochloremia and hypokalemic metabolic alkalosis induced by extremely massive vomiting. The attacks of vomiting were spasmodic and self‐limited. During the episodes of vomiting he fulfilled the criteria of pseudo‐Bartter's syndrome, including hyperreninemia, hyperaldosteronism and normal blood pressure, but in the intervals between attacks he was completely asymptomatic. At the third admission, examination supported an overall clinical picture of bowel obstruction, which was confirmed by radiographic examination. Laparotomy revealed a midgut volvulus with intestinal malrotation. After surgery he made a good recovery and was symptom‐free. In this patient, the high degree of hypochloremia and hypovolemia activated the renin‐angiotensin‐aldosterone system, then aldosterone promoted intensive reabsorption of sodium and excretion of potassium into the urine. Consequently the diagnosis of pseudo‐Bartter's syndrome was established on the basis of an extreme decrease in urinary chloride and an increase in urinary potassium concentration. It is relatively rare for vomiting due to intestinal malrotation to induce pseudo‐Bartter's syndrome. The importance of considering this rare diagnosis in such cases is discussed.

Pseudo‐Bartter syndrome due to Hirschsprung disease in a neonate with an extra ring chromosome 8

“…This is known to be attributed to several medical conditions in which there is severe chloride deficiency [Robb et al, 1984;Koshida et al, 1994;Yu et al, 1998]. This is to our knowledge the first case that has been described in association with HD.…”

Biodegradable fumarate‐based drug‐delivery systems for ophthalmic applications

“…The association of hypokalemic and hypochloremic metabolic alkalosis with hyperreninemia and hyperaldosteronism is known as pseudo‐Bartter syndrome. This is known to be attributed to several medical conditions in which there is severe chloride deficiency [Robb et al, 1984; Koshida et al, 1994; Yu et al, 1998]. This is to our knowledge the first case that has been described in association with HD.…”

A Case of Multiple Gastrointestinal Obstructions in a Newborn Presenting With Pseudo-Bartter’s Syndrome

“…Koshida et al reported in 1994 a case of intestinal malrotation causing PBS [5]. The 6-year-old boy described in the case had severe chloride deficiency secondary to episodic attacks of vomiting, and he was internalized thrice before a definite diagnosis was reached.…”

“…Other than cystic fibrosis, vomiting -disregarding the reasons -seems to be the most common reason for PBS. PBS caused by gastrointestinal (GI) losses due to obstruction and vomiting reported in literature may or may not be associated with other co-existing anomalies [4,5]. There are rare neonatal cases with PBS, in the early postnatal period, related to their mothers' eating disorders and hyperemesis gravidarum, and the mothers also have laboratory findings similar to their babies [6,7].…”