Case Report: Adult-Onset Bartter Syndrome with Hypokalemic Paralysis

Abstract

Background: Adult-onset Bartter syndrome (BS) is rare, typically presenting with hypokalemic paralysis and metabolic alkalosis in Asian populations. Case Presentation: An 18-year-old Pakistani male presented with acute bilateral lower limb weakness (power 2/5) and hand cramps after standing at night. Labs showed severe hypokalemia (K⁺ 1.7 mEq/L), metabolic alkalosis (pH 7.51), hyperreninemia (62 µIU/mL), and high urinary potassium excretion, confirming BS diagnosis. Management: Treated with potassium replacement, spironolactone 25 mg BD, and indomethacin 100 mg OD. Serum K⁺ normalized to 3.2 mEq/L by day 23, full motor recovery achieved. Conclusion: This case highlights adult-onset BS mimicking periodic paralysis, emphasizing early electrolyte correction and aldosterone/prostaglandin inhibition. Physiotherapy post-stabilization aids rehabilitation.