Abstract
Profound hypokalemia can occasionally present as acute paralysis. If not recognised promptly, the outcome can be catastrophic. Among the several causes of potassium loss, distal renal tubular acidosis (dRTA) is uncommon. It arises as a part of an autoimmune process such as primary Sjögren’s syndrome. We describe a fifty-six-year-old woman who came to the Emergency Department with the sudden onset of flaccid quadriparesis and breathlessness for 1 day. Investigations revealed severe hypokalemia (1.7 mmol/l) accompanied by a normal-anion-gap metabolic acidosis. Urinary analysis confirmed dRTA, and further evaluation identified previously undiagnosed primary Sjögren’s syndrome. After timely potassium correction, alkali therapy, and short-course corticosteroids, the patient recovered fully neurologically. This case highlighted the importance of evaluating the cause of hypokalemia and considering Sjögren’s syndrome even in the absence of other initial manifestations.
Fathimathu Afrah, Pulkit Mehrotra, Vengadakrishnan
