A Case of Sj gren's Syndrome Presented as Hypokalemic Periodic Paralysis due to Distal Renal Tubular Acidosis / 대한류마티스학회지

ABSTRACT

Distal renal tubular acidosis (dRTA) can be associated with some autoimmune disease such as systemic lupus erytheuatosus, Sj gren's syndrome, and rheumatoid arthritis. Although hypokalemia in Sj gren's syndrome is a frequent complication, severe symptomatic hypokalemia has been reported only in few cases. Recently we experienced a case of Sj gren's syndrome diagnosed after the discovery of distal renal tubular acidosis with severe hypokalemia manifestating periodic weakness, myalgia in lower extremities, nausea, vomiting, and flaccid paralysis. She complained continuous sensation of dryness of her eyes and mouth. After the Schirmer's test, salivary scan, serologic tests, and lip biopsy, Sj gren's syndrome was confirmed. Intravenous and oral potassium replacement was started immediately, oral sodium bicarbonate later. Marked improvement in periodic paralysis was noted within a few hours and she was fully regained her muscle strength within 48 hours. She discharged with oral sodium bicarbonate and artificial tears. With this treatment blood pH and potassium were kept in the normal range during follow up visits.