Surreptitious habitual vomiting simulating Bartter's syndrome

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Abstract
A patient with hypokalemic alkalosis, normotensive hyperreninism, hyperaldosteronism, increased levels of urinary and plasma prostaglandin E, and vascular hyporesponsivity to angiotensin II was thought to have Bartter''s syndrome. Results of a kidney biopsy showed hyperplasia of the juxtaglomerular apparatus but no renomedullary cell hyperplasia. A 24-h urine collection showed a low Cl- level and no increase in the fractional Cl- clearance, thus excluding Bartter''s syndrome. Subsequent disclosure of surreptitious, habitual vomiting explained the hypokalemia.

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