Colistin-induced Acquired Bartter-like Syndrome: A Rare Cause of Difficult Weaning

Area of Science:

• Nephrology
• Pharmacology
• Critical Care Medicine

Background:

• Colistin is a last-resort antibiotic for multidrug-resistant Gram-negative infections.
• Nephrotoxicity and neurotoxicity are known adverse effects of colistin.
• Acquired Bartter-like syndrome is a rare but significant complication.

Purpose of the Study:

• To report a rare case of colistin-induced acquired Bartter-like syndrome.
• To highlight this syndrome as a cause of difficult weaning in critically ill patients.
• To increase awareness among clinicians regarding this potential adverse drug reaction.

Main Methods:

• Case report of a patient with difficult weaning.
• Clinical presentation, laboratory findings, and treatment are described.
• Review of relevant literature on colistin toxicity and Bartter-like syndrome.

Main Results:

• The patient developed hypokalemia, metabolic alkalosis, and hyperreninemia consistent with Bartter-like syndrome.
• Discontinuation of colistin led to gradual improvement of electrolyte imbalances and easier weaning.
• This adverse event was attributed to colistin administration.

Conclusions:

• Colistin can induce acquired Bartter-like syndrome, presenting as a diagnostic challenge in weaning failure.
• Early recognition and discontinuation of colistin are crucial for management.
• This emphasizes the need for vigilant monitoring of electrolyte balance in patients receiving colistin.