Hypokalemic paralysis caused by distal renal tubular acidosis associated with autoimmune diseas

Abstract

Background & Significance : Hypokalemic paralysis showing periodic course is usually caused by thyrotoxicosis, renal or gastrointestinal loss, primary hyperaldosteronism. But, hypokalemic paralysis associated with renal tubular acidosis presents with prolonged and progressive motor weakness which might be confused with Guillain Barre syndrome. We report the case of hypokalemic paralysis presenting with prolonged and progressive motor weakness caused by RTA associated with Sjogren syndrome and Hashimoto’s thyroiditis. Case : Sixty four year-old female admitted due to slowly progressed quadriparesis, dysarthria and dysphagia for 6 months. She complained dry mouth and arthralgia on multiple joints. On past history she had history of Hashimoto’s thyroiditis. Laboratory finding are follows : Na=140mmEq, K=1.5mmEq, Cl=116mmEq, TCO2=3.3mmEq, pH = 7.261, ANA (+), SS-A(+). According to Physical exam and laboratory findings, diagnosis was compatible to Sjogren syndrome and Hashimoto’s thyroiditis. Conclusions or Commentes : In this case we report unusual case of hypokalemic paralysis caused by distal renal tubular acidosis associated with two autoimmune disease.