Hypokalemic Muscular Paralysis Causing Acute Respiratory Failure Due to Rhabdomyolysis with Renal Tubular Acidosis in a Chronic Glue Sniffer

We report a case of hypokalaemic quadriplegia with acute respiratory failure and life-threatening cardiac arrhythmias in a 26-year-old woman who was diagnosed to have distal renal tubular acidosis. She had persistent metabolic acidosis with severe hypokalaemia and required mechanical ventilation and potassium replacement. The anaesthetic implications of renal tubular acidosis are also discussed.

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Hypokalaemic quadriparesis with respiratory failure due to latent Sjogren syndrome

BMJ Case Reports ◽

10.1136/bcr-2021-243057 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243057

Author(s):

Archita Makharia ◽

Manoj Lakhotia ◽

Mudita Gupta ◽

Pradeep Lalwani

Keyword(s):

Respiratory Failure ◽

Autoimmune Disease ◽

Renal Tubular Acidosis ◽

Respiratory Muscle ◽

Sudden Onset ◽

Distal Renal Tubular Acidosis ◽

Sjogren Syndrome ◽

Muscle Paralysis ◽

Multiple Organs ◽

Renal Tubular

Sjogren’s syndrome (SS) is an autoimmune disease with involvement of multiple organs, including both glandular and extraglandular organs. Usually involvement of glandular organs manifests before the extraglandular ones, but when the sequence is reversed, diagnosis may be missed. Hypokalaemic quadriparesis in SS is not uncommon. Respiratory failure in hypokalaemia is not usually seen, but in SS, it has been reported. We report a case of a 55-year-old woman who presented with sudden onset flaccid quadriparesis and respiratory muscle paralysis secondary to severe hypokalaemia. On detailed investigation, she was detected to have distal renal tubular acidosis secondary to clinically inapparent and asymptomatic SS.

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Hypokalemic Paralysis Leading to Respiratory Failure: An Unusual Presentation of Sjogren’s Syndrome

Austin Critical Care Case Reports ◽

10.26420/austincritcarecaserep/2021.1030 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Ayyawar H ◽

◽

Kothari N ◽

Sharma A ◽

Bhatia P ◽

...

Keyword(s):

Respiratory Failure ◽

Sjögren’S Syndrome ◽

Renal Tubular Acidosis ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Distal Renal Tubular Acidosis ◽

Inflammatory Disorder ◽

Renal Tubular ◽

Sjögren‘S Syndrome

Sjogren’s Syndrome (SS) is a chronic multisystemic autoimmune inflammatory disorder with predominant exocrine gland involvement resulting in dryness of the eyes and mouth. Among extra glandular manifestations, renal involvement is commonly seen, which can be in the form of Renal Tubular Acidosis (RTA). SS may at times present as mild hypokalaemia with distal RTA but severe hypokalemia resulting in respiratory failure is rare. Here we report a case of twenty-five-year-old female presenting in emergency room with flaccid quadriparesis and hypercapnic respiratory failure. Further evaluation revealed hypokalemia (Potassium (K+) 1.6mmol/L) with distal renal tubular acidosis along with a background of primary Sjogren’s Syndrome. We illustrate that the possibility of Sjogren’s Syndrome should be considered in a young female who present with rapidly progressive weakness, hypokalemia and distal renal tubular acidosis with respiratory failure.

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