Sjogren's syndrome with distal renal tubular acidosis presenting as hypokalaemic paralysis

Vaidya, Gaurang; Ganeshpure, Swapnil

doi:10.1136/bcr-2012-007568

Cited by 14 publications

(9 citation statements)

References 7 publications

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“…We later confirmed that the patient’s low-serum potassium and plasma HCO 3 − levels eventually normalized after a month. Taken together, these data suggested that the patient was probably suffering from distal renal tubular damage17 during the period of severe hypernatremia/hyperchloremia. Thereafter, the patient has fully recovered with no further disturbances of consciousness and with normal oral fluid intake, and continues to receive treatment for multiple myeloma.…”

Section: Case Reportmentioning

confidence: 62%

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

Imashuku

Kudo²,

Kubo³

2013

JBM

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A 77-year-old male was admitted to hospital after suffering a pelvic bone fracture in a road traffic accident and was incidentally found to have IgG-kappa-type multiple myeloma with hypercalcemia. The patient was also noted to be hypokalemic and had low HCO3−, with possible damage to the distal tubules in the kidneys. When the treatment was begun with bortezomib/dexamethasone/elcatonin and sodium bicarbonate (NaHCO3) in normal saline (equivalent to a daily sodium dose of 200 millimoles per liter [mmol/L]), the patient was in a state of poor oral fluid intake. The patient developed hypernatremia and hyperchloremia, with a peak serum sodium and chloride levels of 183 mmol/L and 153 mmol/L, respectively, at the sixth day after the start of treatment. Following the switch of the intravenous infusions from normal saline to soldem 1 and soldem 3 solutions, these high-electrolyte levels gradually returned to normal over the next 7 days. Although the patient showed disturbed consciousness (Japan Coma Scale = JCS-I-3) during the period of electrolyte abnormality, he eventually fully recovered without sequelae. In this patient, we successfully managed the severe hypernatremia/hyperchloremia, caused by the combined effects of intravenous saline burden in a state of poor oral fluid intake, during the treatment for IgG-kappa type multiple myeloma.

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Section: Case Reportmentioning

confidence: 62%

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

Imashuku

Kudo²,

Kubo³

2013

JBM

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“…In the early diagnosis era of autoimmune diseases (like in rheumatoid arthritis), the importance of recognizing kidney involvement before glandular symptoms appear has been observed previously [ 21 , 25 , 28 ]. Also, we consider it important to determine whether some factors can trigger the beginning of this manifestation.…”

Section: Discussionmentioning

confidence: 99%

Hypokalemic Paralysis due to Primary Sjögren Syndrome: Case Report and Review of the Literature

Garza-Alpirez

Arana-Guajardo

Esquivel‐Valerio

et al. 2017

Case Reports in Rheumatology

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Tubulointerstitial nephritis (TIN) is the main renal involvement associated with primary Sjögren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephrogenic diabetes insipidus, proximal tubular dysfunction, and others. We present a 31-year-old female with hypokalemic paralysis due to distal RTA (dRTA). She received symptomatic treatment and hydroxychloroquine with a good response. There is insufficient information on whether to perform a kidney biopsy in these patients or not. The evidence suggests that there is an inflammatory background and therefore a potential serious affection to these patients, such as hypokalemic paralysis. We found 52 cases of hypokalemic paralysis due to dRTA in pSS patients. The majority of those patients were treated only with symptomatic medication. Patients who received corticosteroids had stable evolution even though they did not have another symptomatology. With such heterogeneous information, prospective studies are needed to assess the value of adding corticosteroids as a standardized treatment of this manifestation.

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“…Vaidya et al 2 described a young woman with hypokalaemic periodic paralysis subsequently diagnosed to have RTA with hypokalaemia. Unfortunately, the diagnosis of underlying Sjogren's syndrome was only made when the patient developed sicca symptoms.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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We report the case of a 40-year-old housewife, who presented with vomiting since past 5 days and weakness of all four limbs since 1 day. Clinical examination confirmed the presence of flaccid quadriparesis with preserved tendon reflexes. Routine laboratory parameters showed severe hypokalaemia. On further evaluation she was diagnosed to have type 1 renal tubular acidosis secondary to Sjogren's syndrome. Sicca symptoms were conspicuous by their absence.

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Sjogren's syndrome with distal renal tubular acidosis presenting as hypokalaemic paralysis

Cited by 14 publications

References 7 publications

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

Hypokalemic Paralysis due to Primary Sjögren Syndrome: Case Report and Review of the Literature

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

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