Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
22 (
5
); 402-403
doi:
10.4103/0971-4065.103921

Hypokalemic quadriparesis in an elderly female

Department of Medicine, Sher-I-Kashmir Institute of Medical Sciences, Medical College and Hospital, Srinagar, India.
Department of Blood Bank, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Address for correspondence: Dr. Muzafar Ahmed Naik, Department of Medicine, Sher-I-Kashmir Institute of Medical Sciences Medical College and Hospital, Srinagar, Kashmir- 190 011, India. E-mail: muzafarnaik@rediffmail.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

A 65-year-old normotensive, nondiabetic female presented to the emergency department with sudden onset quadriparesis of one day duration. She had history of multiple tooth extractions over the last 10 years. She also had dryness of mouth and eyes of same duration. On examination her pulse was 84/min, BP 130/70 mmHg and poor oral dental hygiene. Systemic examination was normal. The hemoglobin was 7.5 gm/dL, TLC: 6.5 × 109/L, N 76% L 14% M 5% E 5 %, PLT 121 × 109/L. Her random blood sugar was 132 mg/dL, urea 36 mg/dL, creatinine 1.1 mg/dL, bilirubin 0.52 mg/dL, AST 30 U/L, ALT 34 U/L, alkaline phosphatase 288 U/L, total protein 8.5 mg/dL, albumin 3.5 mg/dL. The urinealysis ECG and chest skiagram were normal.

Arterial blood gas analysis showed ABG-pH of 7.32, HCO3 11.3 mmol /L, pO2 63 mm Hg pCO2 29.4 mm Hg, Na 134 mmol/L, K 1.5 mmol/L. and urinary pH 6.5. The Schirmer's test indicated severely dry eyes (<4 mm). Histopathology of salivary gland revealed chronic mononuclear cell infiltration with mild atrophy of glandular component consistent with Sjogrens syndrome. The patient did not afford antibody testing.

The diagnosis of Sjogren syndrome was established as our patient fulfilled four out of the six criteria of the revised international classification criteria for Sjogren syndrome. The patient's symptoms improved dramatically after correcting serum potassium and patient was discharged on potassium supplements and oral sodium bicarbonate tablets.

The overall prevalence of Sjogren syndrome in India is low. Porkodi et al.[1] reported 36 patient of Sjogren syndrome over a period of 4 1/2 year out of 8000 patients seen with musculoskeletal symptoms amounting to 0.0045%. In another report from Lucknow, only 26 cases of Sjogren’ syndrome were described over a period of 10 years.[2] The low prevalence can be due to lack of awareness.

Type 1 renal tubular acidosis presenting as hypokalemic paralysis in Sjogren syndrome has been reported globally.[3] It may be the first presentation of Sjogren syndrome despite long duration of exocrine gland involvement or it may precede the sicca symptoms. Chen et al.[4] found that renal tubular acidosis was the initial manifestation of primary Sjogren's syndrome in 75% out of a series of eight cases. The disease duration was shorter in patients with renal involvement than in those with normal acidification results.[5] Therefore, in patients presenting as hypokalemic paralysis a clinical suspicion can unmask a sub clinical Sjogren syndrome.

References

  1. , , , , , , . Primary Sjogren syndrome-clinical and immunological features. J Ind Rheumatol Assoc. 2003;11:63-5.
    [Google Scholar]
  2. , , , , , , . Primary Sjogren's syndrome: rarity in India. J Assoc Physicians India. 2003;51:859-62.
    [Google Scholar]
  3. , , , , , , . Respiratory paralysis in Sjogren syndrome with normal renal function. Natl Med J India. 2003;16:253-4.
    [Google Scholar]
  4. , , , , , , . Renal tubular acidosis in patients with primary sjogrens's syndrome. J Rheumatol R.O.C.. 2007;21:13-9.
    [Google Scholar]
  5. , , , , , , . Renal involvement in patients with primary Sjogren's syndrome. Scand J Rheumatol. 1989;18:231-4.
    [Google Scholar]

    Fulltext Views
    63

    PDF downloads
    56
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections