Self-induced vomiting presenting as Bartter's syndrome

The physiologic effects of habitual vomiting mimic the metabolic abnormalities seen in Bartter's syndrome, ie, hypokalemic metabolic alkalosis and increased plasma renin and aldosterone levels with kaliuresis. However, in habitual vomiting, the 24-hour urine chloride level will be lss than 10 mEq/liter owing to gastrointestinal loss and in Bartter's syndrome it will be greater than 20 mEq/liter owing to defective chloride reabsorption. The case is reported of a young woman whose self-induced vomiting caused metabolic abnormalities consistent with a diagnosis of Bartter's syndrome. The absence of urinary chloride wasting, ie, level less than 10 mEq/liter, was the only finding distinguishing her condition from Bartter's syndrome and leading to the correct diagnosis.