Treatment and Management on Readmission:
The patient’s readmission warranted a comprehensive and multidisciplinary approach to address the complex interplay of Bartter syndrome, hydrocephalus, and ventriculitis. Following the readmission, the treatment and management plan was devised as follows:
  1. Nasogastric (NG) feeding was initiated to address poor oral intake and ensure proper nutrition, a common approach in managing complex cases [2].
  2. Intravenous (IV) electrolyte management was carried out to correct and maintain electrolyte levels, given the electrolyte imbalance in Bartter syndrome [1].
  3. IV Vancomycin was administered for the first 10 days of admission to combat ongoing meningitis and ventriculitis, as recommended in neonatal meningitis [3].
  4. IV Meropenem was started from day 9 of admission and continued for 19 days to provide broad-spectrum antibiotic coverage, following guidelines for neonatal meningitis [10].
  5. IV Teicoplanin (Targocid) was initiated on day 8 of admission and continued until the establishment of the external ventricular drain (EVD) [8].
  6. Intrathecal teicoplanin was administered via the EVD in seven doses to target ventriculitis, a protocol often used in ventriculitis management [10].
  7. IV Lacosamide (Lerrace) was given to control neurological symptoms, as is frequently done in cases with neurological complications [2].
  8. Oral potassium chloride (K-lyte) was prescribed at 4 mg/kg/day to manage hypokalemia, a hallmark of Bartter syndrome [7].
  9. Mytol drops were administered to address vitamin D deficiency.
  10. Indomethacin was given at 2 mg/kg/day for managing Bartter syndrome, following newer treatment approaches [6].
  11. Prostaglandin inhibitors were used to help control the effects of Bartter syndrome [6].
  12. Ceftriaxone, Colistin, and Dexamethasone injections were used to manage the ongoing infection and inflammation [8].
  13. Oral omeprazole (Risek) was prescribed for gastroprotection.
  14. Voriconazole was administered for antifungal prophylaxis.
The patient’s treatment and management were closely monitored with regular laboratory investigations, to ensure optimal clinical response and minimize the risk of complications [2]. This case report demonstrates the importance of a coordinated, interdisciplinary approach and meticulous monitoring in the management of patients with Bartter syndrome [1] and superimposed neurological complications [9] due to hydrocephalus [4] and ventriculitis [5].