Which of the following NSAID is used for Bartter syndrome?
**Core Concept**
Bartter syndrome is a rare genetic disorder characterized by impaired salt reabsorption in the thick ascending limb of the loop of Henle, leading to hypokalemia, metabolic alkalosis, and normal to low blood pressure. To manage this condition, a medication that inhibits the sodium-potassium-chloride cotransporter (NKCC2) is required.
**Why the Correct Answer is Right**
The correct answer is **B. Bumetanide**. Bumetanide is a loop diuretic that specifically targets the NKCC2 cotransporter in the thick ascending limb of the loop of Henle. By inhibiting this transporter, bumetanide reduces sodium, potassium, and chloride reabsorption, which helps to correct the electrolyte imbalances seen in Bartter syndrome. This mechanism is distinct from other loop diuretics like furosemide, which also inhibit the Na-K-Cl cotransporter but have a broader range of effects.
**Why Each Wrong Option is Incorrect**
**Option A:** Indomethacin is a non-selective NSAID that inhibits COX enzymes, leading to a decrease in prostaglandin synthesis and subsequent effects on renal function. However, it is not specifically used to treat Bartter syndrome.
**Option C:** Furosemide is a loop diuretic that inhibits the Na-K-Cl cotransporter, but it is not the preferred agent for Bartter syndrome due to its broader range of effects and potential for causing hypokalemia.
**Clinical Pearl / High-Yield Fact**
Bartter syndrome is a rare but important consideration in patients with hypokalemia and metabolic alkalosis, and the use of bumetanide can help to correct these electrolyte imbalances.
**Correct Answer: B. Bumetanide**