Abstract
Introduction: Hypoxic respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia. High-flow nasal cannula (HFNC) improved the survival rate among patients with acute hypoxic respiratory failure. Due to physiological alterations, pregnancy can exacerbate distal renal tubular acidosis (dRTA). Pregnancy complicated by hypokalemic periodic paralysis (HPP) poses significant risks due to the potential cardiac and respiratory failure related to low potassium levels.
Case description: A woman, 21 years old, pregnant with her first child at 33-34 weeks gestation came with complaints of shortness of breath one day before admission. Complaints accompanied by cramps in both legs. On the second day, the respiratory rate (RR) suddenly increased to 35x/min, and oxygen saturation (SpO2) was 95% on a non-rebreathing mask (NRM) at 15 l/min. The patient was transferred to the Intensive Care Unit (ICU) with a diagnosis of primigravida at 33-34 weeks, respiratory failure, HPP, suspected dRTA, severe metabolic acidosis, sepsis, and urinary tract infection (UTI). She was given O2 via HFNC at flow 40 l/min and a fraction of inspired oxygen (FiO2) 66%. Improvement was seen on the 4th day; the patient’s shortness of breath was reduced with HFNC, and the patient’s motor strength improved.
Conclusion: The use of HFNC showed a positive outcome and was proven to have been successful in treating hypoxic respiratory failure in pregnant women. Respiratory muscle weakness and severe metabolic acidosis caused by dRTA and HPP cannot be cleared due to the limited settings in rural areas. Furthermore, the assessment and management of HPP and dRTA are still limited in many hospitals in remote areas of Indonesia.
Bintang Hansel, Felicia Handoko, Maya Permatasari Suyata
