Abstract
Patients with Bartter's syndrome, which is characterized by hypokalemia, metabolic alkalosis and hyperaldosteronism, rarely develop respiratory disturbances. We report the case of a 37-years-old woman with Bartter's syndrome, who developed respiratory failure due to muscle paralysis, and who required artificial ventilation by tracheal intubation. Although her conscious level cleared at 6 hours after admission, her voluntary ventilation was not recovered due to severe hypokalemia. Several factors such as cessation of oral potassium intake because of persistent unconsciousness induced by administration of a minor tranquilizer, Triazolam, and accidental hypothermia contributed to the hypokalemia. Insulin administration for hyperglycemia might be related to persistent hypokalemia. To normalize the potassium level and to ameliorate the respiratory condition, potassium supplementation, potassium saving diuretics and indometacin administration to inhibit prostaglandin synthesis in the kidneys may be utilized. Clinically it is important to know that a patient with Bartter's syndrome can develop severe hypokalemia and respiratory disturbances, if certain factors of hypokalemia overlap management of Bartter's syndrome.
