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Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 82-84

Adult-Onset Distal Renal Tubular Acidosis with Hypokalemic Quadriparesis in a Patient with Autoimmune Hypothyroidism

Department of Medicine, Sri Devaraj Urs Medical College, Tamaka Kolar, Karnataka, India

Correspondence Address:
Santoshi Malkarnekar
Department of Medicine, Sri Devaraj Urs Medical College, Tamaka Kolar, Karnataka - 563 101
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2225-1243.143392

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A 40-year-old lady, a known case of hypothyroidism, presented with 1-day history of progressive weakness in all four limbs and reported a history of similar episodes since 3 years. Clinical examination revealed grade 2 hyporeflexic quadriparesis without any bulbar involvement. Workup revealed hypokalemia, non-anion gap hyperchloremic metabolic acidosis and alkaline urine suggestive of distal renal tubular acidosis (RTA). Antiperoxidase and antithyroglobulin antibodies were positive, suggestive of an autoimmune basis for hypothyroidism. She was managed with intravenous potassium chloride, thyroid replacement and bicarbonate therapy, following which remarkable recovery was noted. One week later, she was discharged on oral thyroxine and oral sodium bicarbonate and she remained weakness-free for a follow-up period of over 1 year. RTA presenting in a setting of autoimmune hypothyroidism is a rare occurrence and the possible role of immunological mechanisms and thyroxine deficiency in the pathogenesis of acidification defect seems most likely.

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