Polymyxin B-induced Bartter syndrome.

Area of Science:

• Nephrology
• Clinical Pharmacology
• Genetics

Background:

• Bartter syndrome is a genetic disorder with metabolic alkalosis, hypokalemia, hypomagnesemia, and hypercalciuria.
• Acquired Bartter syndrome can be induced by medications like polymyxins and aminoglycosides.
• Polymyxin B and colistin (polymyxin E) are clinically used, with colistin more frequently linked to nephrotoxicity.

Observation:

• A middle-aged male patient presented with symptoms mimicking Bartter syndrome.
• The patient developed acquired Bartter syndrome attributed to polymyxin B treatment.
• Symptoms resolved upon discontinuation of polymyxin B and reappeared upon its reintroduction.

Findings:

• Polymyxin B can cause nephrotoxicity leading to acquired Bartter syndrome.
• Kidney handling differences between polymyxin B and colistin may influence their nephrotoxic potential.
• This case demonstrates a reversible drug-induced Bartter syndrome.

Implications:

• Clinicians should be vigilant for polymyxin B-induced nephrotoxicity, especially in patients presenting with Bartter syndrome-like symptoms.
• Monitoring kidney function is crucial during polymyxin B therapy.
• Understanding drug-induced nephrotoxicity is vital for patient safety and effective treatment strategies.