Hypokalemic quadriparesis in Sjogren syndrome

Abstract

We report a 58-year-old woman who presented with acute quadriparesis, bulbar weakness, atrial fibrillation, ventricular ectopics, and distal renal tubular acidosis with severe hypokalemia. She recovered completely on potassium and alkali supplementation. The patient also had hypergammaglobulinemia with probable primary Sjogren syndrome.

A case of quadriparesis due to renal tubular acidosis accompanied by vitamin D deficiency in Sjogren's syndrome

“…5 Naik et al in 35 year old female patient who presented with quadriparesia, also dryness of mouth and eyes was present. In the patient with hypokalemic, dRTA, ANA and anti-SSA and anti-SSB positivity and Schirmer's test positive, pSS was diagnosed.…”

“…In spite of metabolic acidosis urine pH cannot be down loaded under 5. 5 Patients with dRTA display a positive urine anion gap and a normal plasma anion gap, distinguhing it from ot her types of acidosis, such as ketoacidosis, lactic acidosis and acidosis due to poisoning with solvents or drugs, with a higher plasma anion gap than normal. Hypokalemia is the most common electrolyte abnormality in patients with dRTA.…”

Primary presentation with acute flaccid quadriparesis in Sjogren's syndrome sans sicca

“…Palkar et al reported another case of RTA with severe hypokalaemia owing to underlying Sjogren's syndrome, unmasked by fever and dehydration 5. In that instance, the patient developed bulbar paralysis and cardiac dysrhythmia in addition to quadriparesis.…”

Hypokalemic quadriparesis due to renal tubular acidosis in a patient with Sjögren’s syndrome: A case series

“…7 Life threatening hypokalemia with muscle paralysis is most serious clinical consequence of distal renal tubular acidosis. 8 The hallmark of renal tubular acidosis (RTA) is a low rate of ammonium excretion by the kidneys in the presence of chronic metabolic acidosis. We did not have detailed urine chemistry available and could not accurately determine urine ammonium concentration but it is safe to assume that ammonium excretion is low if the urine has an alkaline pH.…”

“…8 A renal biopsy is unnecessary in the patients with suspected tubulointerstitial nephritis. 15 We did not perform kidney biopsy in these patient as there were no features suggestive of glomerular involvement such as heavy proteinuria or loss of renal function.…”