PEDIATRICS Vol. 66 No. 5 November 1980, pp. 784-786
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Neo-Mull-Soy Metabolic Alkalosis: A Model of Bartter's Syndrome?

Vivian M. Reznik MD1, William R. Griswold MD1, Stanley A. Mendoza MD1, and Richard M. McNeal MC, USN2

1 University of California at San Diego
2 Naval Regional Medical Center, San Diego, California

A case of Neo-Mull-Soy-induced metabolic alkalosis occurred in an 8-month-old child. This child had hypochloremic hypokalemic alkalosis as well as hyperreninemia. Initially, a diagnosis of Bartter's syndrome was made and treatment consisted of KCl replacement, indomethacin, and aspirin. In retrospect, the diagnosis of Neo-Mull-Soy induced metabolic alkalosis could have been suspected on the basis of the low chloride concentration in his urine. Proposed mechanisms for the etiology of Bartter's syndrome are reviewed. Neo-Mull-Soy induced metabolic alkalosis simulates Bartter's syndrome and supports the concept that the primary abnormality in Bartter's syndrome is chloride deficiency. The chloride deficiency in Bartter's syndrome results from a defect in active chloride transport in the thick ascending limb of the loop of Henle.