Paradoxical Hyperkalemia in Bartter Syndrome: A Case Report of Severe Resistant Hyperkalemia Requiring Hemodialysis.

(https://ce.mayo.edu/content/abstract-submission-mayo-clinic-nephrology-hypertension-and-kidney-transplantation-update-2). Bartter syndrome is characterized by severe hypokalemia due to renal tubular defects. A female in late 30s with Bartter syndrome Type IV presented with dizziness. She had been managing severe hypokalemia with intravenous potassium supplementation via an implanted port. She missed her scheduled potassium infusion and presented to the emergency department with a critically high potassium level of 8.2 mmol/L. Additionally, she was diagnosed with acute kidney injury, with a GFR of 39 mL/min down from 72 at her baseline. Her EKG showed QRS widening and tall T waves. Despite administration of multiple shifters, her potassium levels remained elevated. Urgent hemodialysis was initiated, temporarily reducing her potassium levels, but with a rebound to 9.1 mmol/L within hours. After three cycles of hemodialysis over 36 h, her potassium levels finally normalized to 4.7 mmol/L, and no further dialysis was required.