Abstract: PO1120
Idiopathic Bartter Syndrome-Like Phenotype Diagnosed in a Diabetic Patient with COVID-19 Infection
Session Information
- Salt, Potassium, and Water Balance: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolyte, and Acid-Base Disorders
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Sridhar, Abhinaya, Westchester Medical Center, Valhalla, New York, United States
- Kapoor, Aromma, Westchester Medical Center, Valhalla, New York, United States
Introduction
Bartter's syndrome (BS) is a rare genetic tubulopathy affecting the loop of Henle leading to salt wasting.Acquired BS is very rare and is associated with underlying medical conditions or certain drugs.We report a unique case of idiopathic BS-like phenotype that was diagnosed in the setting of COVID infection.
Case Description
71-year-old man with coronary artery disease, hypertension and diabetes presented after a mechanical fall. On admission, he was found to be hypotensive to 107/88 mmHg. Physical exam was within normal limits. Initial blood work was significant for Potassium 2.6 mEq/L,Bicarbonate 34 mEq/L,Calcium 8.0 mg/dL and Magnesium 1.7 mg/dL.Patient also tested positive for COVID-19.Upon further questioning, patient reported a remote history of hypokalemia but never needed any oral supplementation.He denied diuretic use or surreptitious vomiting.Hypokalemia work up revealed increased urinary potassium of 85.4 mEq/L, Renin 15.72 ng/mL/hour and Aldosterone 8 ng/dL.Patient was then started on aggressive intravenous and oral potassium repletion.He continued to require multiple doses of intravenous potassium to maintain potassium levels of 3 mEq/L.He was subsequently started on Eplerenone on Day 3 of admission with excellent response.He remained otherwise asymptomatic from COVID and as his infection improved, hypokalemia stabilized and he was ultimately discharged with a Potassium level of 3.6 mEq/L.
Discussion
The primary defect in BS is in sodium chloride reabsorption in the medullary thick ascending limb of the loop of Henle resulting in hypokalemia, metabolic alkalosis and secondary hyperaldosteronism.Rare cases of acquired BS are reported in association with tuberculosis, sarcoidosis, sjogrens, and certain drugs.All of these were ruled out in our patient and hence a diagnosis of idiopathic BS like phenotype was made.
In our patient, we attribute the BS like phenotype to underlying COVID infection. As his infection improved, his hypokalemia also resolved. Hyperkalemia is a more common finding in COVID infection. However, in our patient, hypokalemia secondary to BS like phenotype was a unique presentation which was challenging to treat.In the absence of usual causes of acquired BS, unexplained hypokalemia in a patient with COVID infection should prompt suspicion for BS-like phenotype.Early and aggressive correction of electrolyte abnormalities is crucial.