[Skip to Content]
[Skip to Content Landing]
March 14, 1980

Surreptitious Habitual Vomiting Simulating Bartter's Syndrome

Author Affiliations

From the Mercy Hospital Department of Medicine, Baltimore (Dr Ramos); the University of Maryland School of Medicine, Baltimore (Drs Ramos and Hall-Craggs); and the Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey (Dr Demers).

JAMA. 1980;243(10):1070-1072. doi:10.1001/jama.1980.03300360042025

A patient with hypokalemic alkalosis, normotensive hyperreninism, hyperaldosteronism, increased levels of urinary and plasma prostaglandin E, and vascular hyporesponsivity to angiotensin II was thought to have Bartter's syndrome. Results of a kidney biopsy showed hyperplasia of the juxtaglomerular apparatus but no renomedullary cell hyperplasia. A 24-hour urine collection showed a low chloride level and no increase in the fractional chloride clearance, thus excluding Bartter's syndrome. Subsequent disclosure of surreptitious, habitual vomiting explained the hypokalemia.

(JAMA 243:1070-1072, 1980)