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:
- Nasogastric (NG) feeding was initiated to address poor oral intake and
ensure proper nutrition, a common approach in managing complex cases
[2].
- Intravenous (IV) electrolyte management was carried out to correct and
maintain electrolyte levels, given the electrolyte imbalance in
Bartter syndrome [1].
- IV Vancomycin was administered for the first 10 days of admission to
combat ongoing meningitis and ventriculitis, as recommended in
neonatal meningitis [3].
- 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].
- IV Teicoplanin (Targocid) was initiated on day 8 of admission and
continued until the establishment of the external ventricular drain
(EVD) [8].
- Intrathecal teicoplanin was administered via the EVD in seven doses to
target ventriculitis, a protocol often used in ventriculitis
management [10].
- IV Lacosamide (Lerrace) was given to control neurological symptoms, as
is frequently done in cases with neurological complications [2].
- Oral potassium chloride (K-lyte) was prescribed at 4 mg/kg/day to
manage hypokalemia, a hallmark of Bartter syndrome [7].
- Mytol drops were administered to address vitamin D deficiency.
- Indomethacin was given at 2 mg/kg/day for managing Bartter syndrome,
following newer treatment approaches [6].
- Prostaglandin inhibitors were used to help control the effects of
Bartter syndrome [6].
- Ceftriaxone, Colistin, and Dexamethasone injections were used to
manage the ongoing infection and inflammation [8].
- Oral omeprazole (Risek) was prescribed for gastroprotection.
- 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].