HYPOKALEMIC PARALYSIS DUE TO DISTAL RENAL TUBULAR ACIDOSIS, CASE REPORT

Abstract

Abstract: Introduction: Distal renal tubular acidosis (dRTA) is a metabolic disease characterized by hypokalemia, hyperchloremic metabolic acidosis and urine pH above 5.5. These findings may be accompanied by hypercalciuria, nephrocalcinosis, nephrolithiasis, jaundice, osteomalacia or rickets in children. Although hypokalemia is frequently seen as a laboratory finding in dRTA, weakness, which is the clinical finding of this deficiency, is rare. Case Report: A 33-year-old female patient was brought to the emergency department (ED) with complaints of weakness, loss of strength in the extremities, and difficulty in breathing. Laboratory analyzes of the patient revealed metabolic acidosis and hypokalemia. Urea and creatinine values were normal. The patient was admitted to the internal medicine department with a preliminary diagnosis of dRTA and hypokalemic paralysis. Initially, parenteral infusion of KCl and NaHCO3 was administered in the treatment. In the follow-up of the patient, it was observed that hypokalemia and metabolic acidosis improved from the 3rd day and clinical findings improved within 36 hours following the replacement therapy. Conclusion: dRTA, which is rare in adults, is among the secondary causes of hypokalemic paralysis. dRTA should be considered among the differential diagnoses in the presence of hypokalemia and metabolic acidosis in patients presenting with bilateral weakness. References: 1-Ahlavat SK, Sachdev A: Hypokalaemic Paralysis. Postgrad Med J. 1999; 75(882):193-7. Doi: 10.1136/pgmj.75.882.193. 2-Batlle D, Kurtzman NA. Distal renal tubular acidosis: pathogenesis and classification. Am J Kidney Dis. 1982; 1:328-344. Doi: 10.1016/s0272-6386(82)80004-8. 3-Koç F, Bozdemir H. Hypokalemic periodic paralysis due to renal tubular acidosis. Ege Tıp Dergisi, 2004; 43 (1): 47–50. 4-De Silva HJ, Senanayake N. Hypokalemic Periodic Paralysis in Central Sri Lanka. Ceyloh Med J. 1994; 39(3):135-137. 5-Emektar E. Acute hyperkalemia in adults. Turk J Emerg Med. 2023; 23 (2), 75. Doi: 10.4103/tjem.tjem_288_22. 6- Aygencel G, Karamercan A, Akinci E, Demircan A, Akeles A. Metabolic syndrome and its association with ischemic cerebrovascular disease. Adv Ther. 2006;23(3):495-501. doi:10.1007/BF02850171 7- Latorre R, Purroy F. Parálisis periódica hipocaliémica: revisión sistemática de casos publicados [Hypokalemic periodic paralysis: a systematic review of published case reports]. Rev Neurol. 2020;71(9):317-325. doi:10.33588/rn.7109.2020377. 8-Tierney LM, McPhee SJ, Papadakis MA: CURRENT Medical Diagnosis & Treatment 39th Edition, USA: Lange Medical Books/McGraw- Hill; 2000. p866-868. 9- Alkaabi JM, Mushtaq A, Al-Maskari FN, Moussa NA, Gariballa S. Hypokalemic periodic paralysis: a case series, review of the literature and update of management. Eur J Emerg Med. 2010;17(1):45-47. doi:10.1097/mej.0b013e32832d6436 10- Goransson LG, Apeland T, Omdal R: Hypokalemic Pareses Secondary to Renal Tubular Acidosis. Tidsskr Nor Laegeforen. 2000; 120(3):324-5.