An Angiotensin Receptor Blocker and Spironolactone Enabled A Withdrawal from Furosemide and KCl in A Patient with Pseudo-Bartter\u27s Syndrome

A 30-year-old woman with pseudo-Bartter\u27s syndrome was referred to our department because of hypokalemic symptoms caused by outrageous abuse of furosemide and by KCl infusion administered to compensate for it. As an attempt to break this vicious cycle, we first tried to change furosemide with azosemide, a long-lasting loop diuretics, to avoid acute excessive diuresis and excretion of potassium. Administration of losartan effectively attenuated the concentration of extremely activated plasma aldosterone. Administration of spironolactone reduced aldosterone breakthrough induced by losartan and the patient was released from both furosemide and KCl. Blocking renin-angiotensin-aldosterone system demonstrated to be an effective treatment for pseudo-Bartter\u27s syndrome by the improvement of the total body potassium level which was decreased before treatment

Sotalol-Induced Coronary Spasm in a Patient with Dilated Cardiomyopathy Associated with Sustained Ventricular Tachycardia

A 54-year-old man with severe left ventricular dysfunction due to dilated cardiomyopathy was referred to our hospital for symptomatic incessant sustained ventricular tachycardia (VT). After the administration of nifekalant hydrochloride, sustained VT was terminated. An alternate class III agent, sotalol, was also effective for the prevention of VT. However, one month after switching over nifekalant to sotalol, a short duration of ST elevation was documented in ECG monitoring at almost the same time for three consecutive days. ST elevation with chest discomfort disappeared since he began taking long-acting diltiazem. Coronary vasospasm may be induced by the non-selective β-blocking properties of sotalol