Case discussion

A Young  woman presented  in Opd for her generalized weakness.

There is no history of associated diseases and no history  given for

Taking any medication. On investigation , She was found to be Low

Potassium( 2.2) , Cl 110, Hco3 27, BUN 16, and Serum Creatinine 1.0.

Her urine revealed K 40, Cl 82, Na 26. 

Her Blood Pressure 110/70.

What is the most likely cause?

.    

         Surreptitious vomiting
      Diuretic abuse

        Bartter syndrome

         Prim. Hyperaldosteronism

Answere: 

  The most likely is Diuretic abuse but it is very difficult to differentiate it from Bartter/

As both are manifested by hypochloremic hypokalemic met. Alkalosis with high urinary CL. A urine drug screen for diuretic can help. As Bartter is rare so we say it is diruretic abuse.