{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T09:01:02Z","timestamp":1781254862257,"version":"3.54.1"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Bartter syndrome (BS) is a rare autosomal recessive salt\u2010wasting tubulopathy characterized by hypokalemic metabolic alkalosis, hyperreninemia, and hyperaldosteronism without hypertension. It usually presents in childhood; however, adult\u2010onset cases are infrequent and often misdiagnosed. We report a young adult male from Pakistan with congenital deaf\u2010mutism who presented with vomiting, irritability, and altered sensorium. Laboratory findings revealed persistent hypokalemia, metabolic alkalosis, and acute kidney injury secondary to sepsis. Despite adequate potassium replacement, hypokalemia persisted, prompting evaluation for a renal potassium\u2010wasting disorder. Further investigations showed elevated urinary sodium, potassium, and chloride with normal magnesium and a normal\u2010to\u2010high urinary calcium\u2010to\u2010creatinine ratio, consistent with Bartter syndrome. The patient was managed with intravenous fluids, antibiotics, and potassium supplementation, followed by the addition of oral potassium chloride and spironolactone. Clinical and biochemical improvement was noted, with normalization of renal function and serum electrolytes at discharge and on follow\u2010up. This case underscores the diagnostic importance of considering Bartter syndrome in adults with refractory hypokalemia and metabolic alkalosis, particularly after excluding more common causes such as vomiting or diuretic abuse. The coexistence of chronic hypotension and prior myocardial infarction highlights the potential cardiovascular implications of chronic hypokalemia. Bartter syndrome may present in adulthood with atypical features. Early recognition through targeted biochemical evaluation and timely initiation of potassium\u2010sparing therapy are crucial for favorable outcomes and prevention of renal and cardiovascular complications, especially in resource\u2010limited settings lacking genetic diagnostic facilities.<\/jats:p>","DOI":"10.1002\/ccr3.72541","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:10:59Z","timestamp":1776226259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adult\u2010Onset Bartter Syndrome Presenting as Refractory Hypokalemia and Metabolic Alkalosis: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"given":"Muhammad","family":"Asif","sequence":"first","affiliation":[{"name":"Registrar Medicine Benazir Bhutto Hospital  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Sanam","sequence":"additional","affiliation":[{"name":"Department of Biochemistry Army Medical College NUMS  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ilyas","sequence":"additional","affiliation":[{"name":"Internal Medicine Trainee Daisy Hill Hospital  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawera","family":"Tahir","sequence":"additional","affiliation":[{"name":"Clinical Fellow Ysbyty Gwynedd Bangor  Wales UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahir","family":"Hanif","sequence":"additional","affiliation":[{"name":"Department of Medicine CMH  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muddassir","family":"Khalid","sequence":"additional","affiliation":[{"name":"Department of Medicine Nishtar Medical University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iqra","family":"Sarwar","sequence":"additional","affiliation":[{"name":"Department of Biochemistry Army Medical College NUMS  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7441-9135","authenticated-orcid":false,"given":"Fred","family":"Segawa","sequence":"additional","affiliation":[{"name":"Department of Medicine Makerere University College of Health Sciences  Kampala Central Region Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJNRD.S155397"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003910"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59091638"},{"key":"e_1_2_13_5_1","first-page":"1","article-title":"Bartter's Syndrome: Clinical Findings, Genetic Causes and Therapeutic Approach","author":"Mrad F. C. D. C.","year":"2020","journal-title":"World Journal of Pediatrics"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.908655"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.31579\/2640-1045\/138"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfaa172"},{"key":"e_1_2_13_9_1","unstructured":"M.Konrad G.Ariceta A.Bertholet\u2010Thomas et\u00a0al. \u201cDiagnosis and Management of Bartter Syndrome: Consensus and Recommendations From the ERKNet Working Group for Tubular Disorders\u201d."},{"issue":"5","key":"e_1_2_13_10_1","first-page":"84","article-title":"An Overview on Barter Syndrome: Literature Review","volume":"11","author":"Albareqy A. H.","year":"2020","journal-title":"Pharmacophore"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad752"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72541","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72541","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72541","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:46:13Z","timestamp":1781253973000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/ccr3.72541"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72541","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-12-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72541"}}