Bartter's syndrome: clinical study of its treatment with salt loading and propranolol

The clinical course of a 9 year old black male with Bartter's syndrome who has been followed since age 1 1/2 years is presented. He had been unable to conserve sodium on a low salt diet and has failed to show improvement in serum electrolytes while on a sodium loading regimen. He is now refractory to spironolactone and KCI therapy, even in conjunction with supplemental sodium. On two separate trials his electrolytes have approached normal with the combination of propranolol and spironolactone along with KCI and NaCl supplementation. However, his response to this regimen has been a temporary one with relapse to the pretreatment chemical status despite increasing doses of propranolol and potassium chloride.