Bartter syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Differentiating Bartter syndrome from other Diseases

Bartter syndrome diagnosis should be differentiated from other diseases manifesting with hypokalemia, normal to low blood pressure, and hypochloremic metabolic alkalosis.

Disease	Findings
Gitelman syndrome	Patients present with dyspnea and fatigability as a consequence of reduced cardiac reserve in the fourth or fifth decade AR murmur is heard over left sternal border or over the right second intercostal space and radiates to the neck
Diuretic abuse	Pansystolic murmur accentuating with inspiration RV heave Gaint "V" wave seen on JVP examination Hepatomegaly is seen in 90% of patients Quantification of severity of TR is done by colour flow doppler imaging
Cyclical vomiting	Usually seen in children with acyanotic congenital disease such as ASD Fixed splitting of S2 is present
Hyperprostaglandin E syndrome	Gradual replacement of normal functional myocardium with adipose or fibroadipose tissue Age of onset is 7 to 40years Patients are usually asymptomatic, present with occasional palpitations EKG shows negative "T" waves and epsilon waves with selective "S" wave delay in V1 to V3 RV is dilated and hypokinetic on echocardiography Holter monitoring helps to diagnose hyperkinetic ventricular arrythmias
Familial hypomagnesemia with hypercalciuria/nephrocalcinosis
Cystic fibrosis
Gullner syndrome - Familial hypokalemic alkalosis with proximal tubulopathy
Mineralocorticoid excess
Activating mutations of the CaSR calcium-sensing receptor
Hypomagnesemia
Congenital chloride diarrhea
Hypochloremic alkalosis
Hypokalemia

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