A woman in her mid-forties had repeated
vomiting and diarrhoea accompanied by
muscle weakness soon after she started taking seven different diet pills imported from Thailand. After she had taken the pills for 8 days,
respiratory depression progressed rapidly to arrest. Blood tests at the Emergency Department showed severe hypokalaemia with metabolic
alkalosis. We diagnosed that she had developed pseudo-
Bartter syndrome from the findings based on ionic abnormalities and high
renin and
aldosterone levels, and
hyperplasia of the juxtaglomerular apparatus. A postmortem blood analysis indicated subtherapeutic levels of
furosemide. We concluded that the patient died from pseudo-
Bartter syndrome, which was triggered by chronic
self-administration of
furosemide and aggravated by the diet pills. This is the first pseudo-
Bartter syndrome autopsy report to show histological localisation of calcification in the kidneys.