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VOLUME 25 , ISSUE 7 ( July, 2021 ) > List of Articles

CASE REPORT

Acquired Bartter-like Syndrome Presenting with Polyuria and Reversible Hypokalemia Associated with Colistin Use in a Critically Ill Pediatric Patient

Damla P Yavas, Faruk Ekinci, Ozden O Horoz, Ozlem O Gundeslioglu, Bahriye Atmis, Dincer Yildizdas

Keywords : Bartter-like syndrome, Colistin, Hypokalemia, Pediatric, Polyuria

Citation Information : Yavas DP, Ekinci F, Horoz OO, Gundeslioglu OO, Atmis B, Yildizdas D. Acquired Bartter-like Syndrome Presenting with Polyuria and Reversible Hypokalemia Associated with Colistin Use in a Critically Ill Pediatric Patient. Indian J Crit Care Med 2021; 25 (7):822-824.

DOI: 10.5005/jp-journals-10071-23898

License: CC BY-NC 4.0

Published Online: 07-07-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

We report a case of an acquired Bartter-like syndrome (BLS) after 3 days of treatment initiation and improved after discontinuation of colistin therapy in pediatric intensive care unit. A 2-month-old girl with spinal muscular atrophy type 1 who had respiratory distress received colistin therapy with a dose of 5 mg/kg/day for Acinetobacter baumannii complex isolation from endotracheal aspirate on the 12th day follow-up. Polyuria (6 mL/kg/hour) in the presence of normal blood pressure and hypokalemic metabolic alkalosis were developed on the 3rd day of colistin treatment. Colistin was stopped on the 4th day, and 2 days after discontinuation of colistin, polyuria improved dramatically. Her metabolic alkalosis and hypokalemia discontinued after 2 and 4 days, respectively. There are very few reports about colistin-induced BLS. The onset of polyuria, hypokalemia, and metabolic alkalosis during treatment with colistin and resolution after interruption suggest a causative relationship.


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  1. Li J, Nation RI, Turnidge JD, Milne RW, Coulthard K, Rayner CR, et al. Colistin: the re-emerging antibiotic for multidrug-resistant Gram negative bacterial infections. Lancet Infect Dis 2006;6(9):589–601. DOI: 10.1016/S1473-3099(06)70580-1.
  2. Tabish M, Mahendran M, Ray A, Vikram NK. Colistin-induced acquired Bartter-like syndrome: an unusual cause of meltdown. BMJ Case Rep 2020;13:e232630. DOI: 10.1136/bcr-2019-232630.
  3. Poirel L, Jayol A, Nordmann P. Polymyxins: antibacterial activity, susceptibility testing, and resistance mechanisms encoded by plasmids or chromosomes. Clin Microbiol Rev 2017;30(2):557–596. DOI: 10.1128/CMR.00064-16.
  4. Javan AO, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol 2015;71(7):801–810. DOI: 10.1007/s00228-015-1865-4.
  5. Cakir U, Alan S, Zeybek C, Erdeve O, Atasay B, Yalcinkaya F, et al. Acquired bartter-like syndrome associated with colistin use in a preterm infant. Ren Fail 2013;35(3):411–413. DOI: 10.3109/0886022X.2012.761084.
  6. Gai Z, Samodelov SL, Kullak-Ublick GA, Visentin M. Molecular mechanisms of colistin-induced nephrotoxicity. Molecules 2019;24(3):653. DOI: 10.3390/molecules24030653.
  7. Berg JR, Spilker CM, Lewis SA. Modulation of polymyxin B effects on mammalian urinary bladder. Am J Physiol 1998;275(2):F204–F215. DOI: 10.1152/ajprenal.1998.275.2.
  8. Florescu DF, Qiu F, McCartan MA, Mindru C, Fey PD, Kalil A. What is the efficacy and safety of colistin for the treatment of ventilator-associated pneumonia? A systematic review and meta regression. Clin Infect Dis 54(5):670–680. DOI: 10.1093/cid/cir934.
  9. Lee BH, Cho HY, Lee H, Han KH, Kang HG, Ha IS, et al. Genetic basis of Bartter syndrome in Korea. Nephrol Dial Transplant 2012;27(4):1516–1521. DOI: 10.1093/ndt/gfr475.
  10. Ben Salem C, Hmouda H, Bouraoui K. Drug-induced hypokalaemia. Curr Drug Saf 2009;4(1):55–61. DOI: 10.2174/157488609787354369.
  11. Kwon J-A, Lee JE, Huh W, Peck KR, Kim Y-G, Kim DJ, et al. Predictors of acute kidney injury associated with intravenous colistin treatment. Int J Antimicrob Agents 2010;35(5):473–477. DOI: 10.1016/j.ijantimicag.2009.12.002.
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