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November 14, 1986

Profound Hypokalemia With Rhabdomyolysis in Bartter's Syndrome

JAMA. 1986;256(18):2518. doi:10.1001/jama.1986.03380180080016

To the Editor.—  Hypokalemia, hyperreninemia, hyperaldosteronism, decreased sensitivity to exogenous angiotensin II, and hyperplasia of juxtaglomerular apparatus on biopsy are the most characteristic findings in Bartter's syndrome. We describe a patient with Bartter's syndrome, rhabdomyolysis, and profound hypokalemia.

Report of a Case.—  A 26-year-old man presented at our hospital with paresis os his proximal muscles. He had no history of vomiting or diarrhea. He took no drugs or other substances known to cause hypokalemia. He had a normal blood pressure. Laboratory values were as follows: hemoglobin, 17.9 g/dL (179 g/L); erythrocytes, 5.25×106/ mm3 (5.25×1012/L); potassium, 1.6 mEq/L (1.6 mmol/L); creatinine, 0.9 mg/dL (79.5 μmol/L); and creatine kinase, 15.390 U/L (reference range, <240 U/L). Myoglobin was present in his urine. Plasma renin activity was increased to 36 ng/mL/h (10 ng·L-1·s-1) (reference range, 2.6 to 3.6 ng/mL/h [0.7 to 1.0 ng·L-1·s-1]), and