Acquired Bartter-like syndrome associated with the use of polymyxin B

Abstract

Bartter-like syndrome (BLS) is a salt-wasting tubular disorder caused by a renal tubular defect in sodium reabsorption in the thick ascending limb of the loop of Henle (TAL) which triggers natriuresis, hypokalemia, and metabolic acidosis. This condition has been associated with certain diseases or medications.

We present the case of a 25-year-old man with osteomyelitis caused by VIM carbapenemaseproducing Pseudomonas aeruginosa treated with polymyxin B (PB) and meropenem who, 16 days after beginning treatment, developed hypokalemia, hypomagnesemia, hypocalcemia, hypochloremic metabolic alkalosis and renal electrolyte losses, with normal kidney function. Polymyxin B-induced BLS was considered as a diagnosis of exclusion. Electrolyte correction was performed and, once treatment was suspended, the metabolic bnormalities improved.