Presentation
Bartter's syndrome: a neonatal presentation (a case report). J Postgrad Med 1992;38:41 How to cite this URL: Contractor C P, Mehta S D, Wagle S U, Desphande P G, Irani S F. Bartter's syndrome: a neonatal presentation (a case report). [jpgmonline.com]
Classic and neonatal Bartter syndrome have similar presenting symptoms but different presentation ages, Gitelman syndrome is found in late childhood or adolescence and has the classic hallmark finding of hypomagnesaemia, which differentiates it from classic [emro.who.int]
Growth faltering, dwarfism, polydipsia, and weakness may be present in older children. Mild mental retardation is reported in few patients. [hindawi.com]
Our findings confirm a recent observation that aBS II can present as late-onset disease in adulthood [4]. Interestingly, this case and our case presented with nephrocalcinosis as incidental presentation of BS. [academic.oup.com]
Cystic fibrosis in Saudi Arabia: Common and rare presentations. Ann Trop Paediatr 1995;15:269-72. [ PUBMED ] 3. Ballestero Y, Hernandez MI, Rojo P, et al. Hyponatremic dehydration as a presentation of cystic fibrosis. [sjkdt.org]
Entire Body System
- Fatigue
Bartter described this syndrome in two African-American patients: a 5 year old boy and a 25 year old man with a long history of slow growth, weakness and fatigue. [flipper.diff.org]
Manifestations vary depending on genotype, but growth and development may be affected and electrolyte abnormalities may cause muscle weakness, cramping, spasms, tetany, or fatigue. [merckmanuals.com]
Symptoms Symptoms of Bartter syndrome may include: generalized weakness and fatigue increased urination (polyuria) increased thirst (polydipsia) waking up at night to urinate (nocturia) mild dehydration craving salt muscle cramping constipation Children [verywell.com]
- Weight Loss
Following birth, neonate should be monitored for urine output, hydration, weight loss, and electrolyte balance. Correction of dehydration and electrolyte imbalance are the important aspects of management. [hindawi.com]
Maximum weight loss was 18% of the birth weight at D4 and birth weight was regained at D20. He presented hypochloremia, hyponatraemia, hyperkalemia up to D7, metabolic alkalosis after the first week of life and hypokalemia since D32 ( Table I ). [scielo.mec.pt]
Neonates suspect for Bartter syndrome should be monitored closely for urine output, hydration status, weight loss and electrolyte balance. The characteristic electrolyte abnormalities include hypokalemia and metabolic alkalosis. [nature.com]
Finally, I will emphasize the diagnosis of anorexia nervosa can be elusive, because in contrast to most patients with loss of weight for other medical conditions (i.e. hyperthyroidism malignancy etc.) who express concern over their weight loss or alterations [omicsonline.org]
- Galactorrhea
Type 1 Excludes transitory endocrine and metabolic disorders specific to newborn ( P70-P74 ) Endocrine, nutritional and metabolic diseases E20-E35 2019 ICD-10-CM Range E20-E35 Disorders of other endocrine glands Type 1 Excludes galactorrhea ( N64.3 ) [icd10data.com]
- Short Stature in Children
Growth delays and growth retardation may be seen as affected children age, and final adult height may be shorter than would otherwise be expected (short stature). [rarediseases.org]
Gastrointestinal
- Failure to Thrive
Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]
Failure to thrive in an infant has multiple etiologies and at times is the only manifestation of underlying serious diseases such as Bartter syndrome, in which the majority of patients present with failure to thrive, vomiting and constipation during the [emro.who.int]
Principal clinical features in most of them include early onset polyhydramnios, failure to thrive, prematurity, and nephrocalcinosis. [hindawi.com]
Presentation is often in childhood with gastrointestinal upset, failure to thrive and polyuria. [gpnotebook.co.uk]
- Polydipsia
Main manifestations of BS with neonatal age: vomiting, diarrhoea, polyuria, polydipsia, signs of dehydration, with infants: hypocalcemic convulsions, paresis hypokalemic. [adc.bmj.com]
[…] cells along with: hypokalemia metabolic alkalosis hypotension/normotension elevated plasma renin elevate aldosterone antenatal polyhydramnios Classification There are two subtypes of Bartter syndrome: classic: presents in early childhood with polyuria, polydipsia [radiopaedia.org]
Because of this, the infant will have condition known as polyuria or excessive urination and polydipsia or excessive consumption of fluids. If the infant does not receive requisite quantities of fluids, the complications could be life-threatening. [medanta.org]
[…] leads to an increase in prostaglandin E (PGE) Genetics inheritance pattern autosomal recessive Prognosis can slowly progress to interstitial fibrosis resulting in chronic renal failure Presentation Symptoms failure to thrive increased thirst polyuria polydipsia [medbullets.com]
Symptoms Symptoms of Bartter syndrome may include: generalized weakness and fatigue increased urination (polyuria) increased thirst (polydipsia) waking up at night to urinate (nocturia) mild dehydration craving salt muscle cramping constipation Children [verywell.com]
Musculoskeletal
- Muscle Weakness
Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]
Some common ones include: Constipation Frequent urination Generally feeling unwell Muscle weakness and cramping Salt cravings Severe thirst Slower than normal growth and development Antenatal Bartter syndrome may be diagnosed before birth. [webmd.com]
Manifestations vary depending on genotype, but growth and development may be affected and electrolyte abnormalities may cause muscle weakness, cramping, spasms, tetany, or fatigue. [merckmanuals.com]
- Muscle Cramp
When to Contact a Medical Professional Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently visHeader References Chan JC, Santos F, Hand M. [nicklauschildrens.org]
Calling your health care provider Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently [coordinatedhealth.com]
Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently Potassium wasting; Salt-wasting nephropathy Guay-Woodford LM. Hereditary nephropathies and developmental abnormalities of the urinary tract. [medlineplus.gov]
When to Contact a Medical Professional Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently References Guay-Woodford LM. [mountsinai.org]
Symptoms include: Growth failure - Rate of weight gain is much lower than that of other children of similar age and gender Constipation Low blood pressure Kidney stones Muscle cramping and weakness Higher urination frequency Causes Bartter syndrome is [medanta.org]
- Carpopedal Spasm
Other symptoms Other symptoms, which appear during late childhood, include fatigue, muscle weakness, cramps, and recurrent carpopedal spasms. Developmental delay and minimal brain dysfunction with nonspecific electroencephalographic changes are also [slideshare.net]
- Proximal Muscle Weakness
Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]
- Trousseau Sign
In addition, some affected patients may have neuromuscular irritability as manifested by a positive Chvostek +/or Trousseau sign or frank tetany due to alkalosis and hypomagnesemia. [madeasy.de]
Urogenital
- Polyuria
After birth he displayed extreme polyuria, severe renal sodium and chloride loss, and marked hypercalciuria. Five weeks after birth, his sodium chloride loss turned into renal potassium loss, along with a marked decrease in urine output. [link.springer.com]
Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]
Main manifestations of BS with neonatal age: vomiting, diarrhoea, polyuria, polydipsia, signs of dehydration, with infants: hypocalcemic convulsions, paresis hypokalemic. [adc.bmj.com]
Prenatal manifestations, mainly recurrent polyhydramnios because of fetal polyuria, lead to premature delivery. After birth, polyuria leads to life-threatening dehydration. Prenatal genetic diagnosis needs an index case. [ncbi.nlm.nih.gov]
- Kidney Failure
Possible Complications Kidney failure or gallstones is a possible complication. [nicklauschildrens.org]
Infants who have severe growth failure may grow normally with treatment. Although most patients remain well with ongoing treatment, some develop kidney failure. Complications Kidney failure is a possible complication. [coordinatedhealth.com]
Kidney function is also normal if the disease is treated,[3] but occasionally patients proceed to end-stage kidney failure. [en.wikipedia.org]
Medicine may be needed that blocks the kidney's ability to get rid of potassium. High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. Infants who have severe growth failure may grow normally with treatment. [medlineplus.gov]
Continuing The Conversation Diseases and conditions like diabetic ketoacidosis, alkalosis, abnormally high aldosterone levels, Bartter syndrome, kidney failure, and certain hereditary problems can impact the levels of blood potassium. [bblc.tv]
- Nocturia
Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]
Symptoms Symptoms of Bartter syndrome may include: generalized weakness and fatigue increased urination (polyuria) increased thirst (polydipsia) waking up at night to urinate (nocturia) mild dehydration craving salt muscle cramping constipation Children [verywell.com]
Bartter Syndrome Symptoms The disorder can lead to a number of moderate to severe symptoms, including: Developmental delay Constipation Low blood pressure Muscle cramping Weakness and fatigue Kidney stone Polyuria or increased urination Nocturia or excessive [hxbenefit.com]
Excessive thirst (polydipsia), excessive urination and the need to urinate at night (nocturia) may also be present. This can lead to dehydration. Some children crave salt. [rarediseases.info.nih.gov]
Workup
The study was exempt from institutional review board approval because, at the time of prenatal diagnosis, amniotic fluid sampling was part of the routine diagnostic workup. RESULTS Bartter groups are presented in Table 1. [nature.com]
Clinical Testing and Workup Laboratory tests that are used to diagnose these disorders include blood tests to determine serum electrolyte levels, specifically potassium, chloride, bicarbonate, magnesium, renin, and aldosterone levels and urine tests to [rarediseases.org]
The classification is as follows (see Etiology, Presentation, and Workup ) [5] : Classic Bartter syndrome and Gitelman syndrome - The first type involves the thick ascending limb of the loop of Henle (TALH) or distal convoluted tubule (DCT) dysfunction [emedicine.medscape.com]
Workup Approach Considerations The severity and site of the mutation determines the age at which symptoms first develop. [slideshare.net]
Serum
- Magnesium Decreased
It is currently unknown why calcium reabsorption is increased while magnesium absorption is decreased, leading to a low level of magnesium in the blood. [en.wikipedia.org]
T Wave
- Prominent U Wave
[…] and prominent U waves. [slideshare.net]
Treatment
Search: name, specialism, conditions, treatments, tests or services Search: name, specialism, conditions, treatments, tests or services Search: name, specialism, conditions, treatments, tests or services Royal Brompton & Harefield NHS Foundation Trust [rbht.nhs.uk]
Outlook (Prognosis) Infants who have severe growth failure may grow normally with treatment. Most patients remain well with ongoing treatment, though some develop kidney failure. [nicklauschildrens.org]
Pathophysiology of hypokalemia helps to identify the course of treatment. To design proper treatment for low potassium levels, the doctor needs to first find out the precise reason for the condition. [bblc.tv]
Standard Therapies Treatment The treatment of the Bartter syndromes is directed toward the specific symptoms that are apparent in each individual. Treatment may require the coordinated efforts of a team of specialists. [rarediseases.org]
At present, there is no specific treatment that can cure the disorder. [hxbenefit.com]
Prognosis
Long-term prognosis is guarded. Lack of satisfactory control may lead to morbidity, growth failure, and renal insufficiency [2, 18, 23]. 8. Prognosis Untreated ABS patients may succumb to dehydration, dyselectrolytemia, and intercurrent infections. [hindawi.com]
Prognosis If recognised early and treated aggressively, children with Bartter syndrome can achieve near-normal growth and intellectual development. [medical-dictionary.thefreedictionary.com]
With early treatment of the electrolyte imbalances the prognosis for patients with Classic Bartter Syndrome is good. History The condition is named after Dr. Frederic Bartter, who, along with Dr. [dictionnaire.sensagent.leparisien.fr]
This can help prevent serious complications from developing in them What is the Prognosis of Bartter Syndrome? (Outcomes/Resolutions) Bartter Syndrome is an incurable condition. [dovemed.com]
Etiology
Mineralocorticoid excess Cystic fibrosis Renal Tubular Defects Category Fanconi Syndrome Bartter Syndrome Gitelman Syndrome Liddle Syndrome Defect localization Proximal tubule Thick ascending loop of Henle Distal convoluted tubule Collecting tubule Etiology [medbullets.com]
An etiology of Bartter syndrome that is usually known as autosomal dominant hypocalcemia or autosomal dominant hypoparathyroidism has been described. [emedicine.medscape.com]
Twin pregnancies, fetal aneuploidy, oligohydramnios, fetal morphologic abnormalities, and cases with a clear etiology of polyhydramnios (duodenal atresia) were excluded. [nature.com]
Failure to thrive in an infant has multiple etiologies and at times is the only manifestation of underlying serious diseases such as Bartter syndrome, in which the majority of patients present with failure to thrive, vomiting and constipation during the [emro.who.int]
Epidemiology
EPIDEMIOLOGY The exact prevalence of this disorder is unknown, although it likely affects about 1 per million people worldwide. Annual incidence is estimated at 1/830,000. [flipper.diff.org]
Introduction Clinical definition a renal tubular disorder characterized by hypokalemia hypochloremia metabolic alkalosis normotension elevated plasma renin level Epidemiology incidence rare precise incidence is unknown demographics in neonatal cases can [medbullets.com]
Epidemiology Gitelman's syndrome is the most common renal tubular disorder among Caucasians (prevalence of 1 in 40,000). Most patients have onset of symptoms as adults, but some can present in childhood. [ 8 ] Bartter's syndrome is rare. [patient.info]
[…] potassium levels are not sufficiently replaced with replacement by mouth, aldosterone antagonists (such as spironolactone or eplerenone ) or epithelial sodium channel blockers such as amiloride can be used to decrease urinary wasting of potassium. [1] Epidemiology [en.wikipedia.org]
Roerig JL, Steffen KJ, Mitchell JE, Zunker C (2010) Laxative abuse: epidemiology, diagnosis and management. Drugs 70: 1487-1503. Baker EH, Sandle GI (1996) Complications of laxative abuse. Annu Rev Med 7: 127-134. [omicsonline.org]
Pathophysiology
Novel insights into the pathophysiology, as well as the recent identification of a novel genetic cause of aBS, merit an update on this topic. [journals.lww.com]
Hypokalemia pathophysiology includes studying the effect of low potassium levels on the body. [bblc.tv]
[…] incidence rare precise incidence is unknown demographics in neonatal cases can be suspected before birth and diagnosed soon after birth in classic cases begins around 2 years of age or younger no race or sex predilection risk factors family history Pathophysiology [medbullets.com]
Contents 1 Features 2 Diagnosis 3 Pathophysiology 4 Treatment 5 Prognosis 6 History 7 Related conditions 8 References 9 External links Features In 90% of cases, neonatal Bartter syndrome is seen between 24 and 30 weeks of gestation with excess amniotic [dictionnaire.sensagent.leparisien.fr]
In this paper, authors present classification, pathophysiology, clinical manifestations, laboratory findings, complications, and prognosis of ABS. 1. [hindawi.com]
Prevention
Other measures include taking potassium supplements, medications to prevent potassium loss from kidneys, and if required, kidney transplantation in case of end-stage renal disease Currently, there are no effective means of preventing Bartter Syndrome; [dovemed.com]
In younger children growth hormone may be used to prevent the short stature and prostaglandin inhibitors to decrease the elevated prostaglandin levels. [flipper.diff.org]
There is no known preventive method that can keep the disorder from occurring as it has a genetic etiology. [hxbenefit.com]
The necessary therapy with nonsteroidal anti-inflammatory drugs (indometacin, celecoxib) drugs potassium prevents the development of complications. [adc.bmj.com]