Hypokalemic Periodic Paralysis Secondary to Distal Renal Tubular Acidosis in a Middle-Aged Diabetic Female with Sjögren’s Syndrome

Abstract

Hypokalemic periodic paralysis (HPP) in this patient presented as episodes of muscle weakness along with low serum potassium levels. In this case, the condition is linked to an underlying renal abnormality. We report a case of a 54-year-old diabetic woman who presented with a sudden onset of weakness in both lower limbs, difficulty lifting her neck and legs, giddiness, dry mouth, dry eyes, poor appetite, constipation, and vomiting. Blood tests revealed severe hypokalemia, non-anion gap metabolic acidosis, and alkaline urine, indicating type 1 dRTA. The ECG showed first-degree AV block with ST-T changes. Despite potassium supplementation, her potassium levels remained low, suggesting renal potassium loss. She was treated with an intravenous potassium chloride infusion, intravenous magnesium sulphate, and oral sodium bicarbonate therapy, which resulted in a gradual improvement in her symptoms. The combination of metabolic acidosis and sicca symptoms supported a diagnosis of type 1 distal renal tubular acidosis, possibly associated with Sjögren’s syndrome. This case demonstrated an association between persistent hypokalemia, neuromuscular weakness, and sicca symptoms, pointing toward an underlying autoimmune-related renal disorder.