A case of pseudo Bartter syndrome in furosemide abuse was described. The case was 24 year-old female, a nurse, who was admitted because of persistent hypokalemia on, she noted pretibial edema for which furosemide was prescribed by a local doctor. Since then, she had taken about 80 mg of furosemide daily until, when transient cardiac and respiratory arrest developed and serum potassium was found to be 2.0 mEq per liter. The patient was advised to discontinue furosemide. Serum potassium, however, remained inn hypokalemic range in spite of potassium supplementation. At admission she appeared healthy and denied using furosemide, diuretics and laxatives. Serum potassium was 2.4, sodium 143, chloride 90 mEq per liter. Arterial blood pH was 7.477 and plasma bicarbonate 31.3 mEq per liter. Diagnosis of pseudo Bartter syndrome was suspected because of 1) persistent hypokalemia with increases in potassium clearance, plasma renin activity, plasma aldosterone concentration 2) low response of blood pressure to angiotensin II 3) minimal to moderate hyperplasia of J-G apparatus 4) no improvement of clinical condition with indomethacin. After discharge, the patient had been well with persistent hypokalemia until, when she became unconscious abruptly followed by generalized convulsion. Serum potassium was 1.5 mEq per liter. Incidentally it was discovered that she had obtained a lot of furosemide from pharmacy without doctor's prescription. At first she insisted not to take furosemide but finally admitted taking furosemide 280 mg daily. It was quite surprising that she had been taking furosemide continuously even though having episodes of cardiac and respiratory arrest, generalized convulsion which, she should know, might be deeply related to f urosemide usage. It is strongly suggested that furosemide abuse would be one another etiologic condition for pseudo Bartter syndrome and furosemide should not be prescribed without careful supervision.
