title: Acute-onset paralysis in a patient of rheumatoid arthritis.
abstract: Renal tubular acidosis (RTA) is a disorder of renal acidification characterized by inability to acidify urine to pH < 5.5 despite the presence of severe systemic metabolic acidosis and hypokalemia. Hypokalemia leads to acute-onset paralysis and may be a presenting manifestation of RTA. Its association with various autoimmune disease has been reported previously in published reports, but has not been much emphasized. We, hereby, report a case of RTA that presented during the flare of rheumatoid arthritis (RA). A 42-year-old female, a known case of RA for 5 years, presented with persistent joint pain for 1 week and acute-onset quadriparesis for 3 days. Primary investigations revealed hypokalemia with metabolic acidosis. She was managed conservatively with potassium supplements and bicarbonate supplements along with steroids and disease-modifying anti-rheumatic drugs. Such a presentation of renal tubular acidosis in a patient during the flare of rheumatoid arthritis is distinctly rare and previously unreported in published studies.
authors.affiliation: Ankur Nandan Varshney, Department of General Medicine,, Institute of Medical Sciences,, Banaras Hindu University,, Varanasi, Uttar Pradesh,, India 221005, T: 9411491192, drankurnvarshney@gmail.com.
authors.forename: Ankur Nandan
authors.initials: AN
authors.lastname: Varshney
authors.forename: Pratibha
authors.initials: P
authors.lastname: Prasad
authors.forename: Nilesh
authors.initials: N
authors.lastname: Kumar
authors.forename: Nand Kumar
authors.initials: NK
authors.lastname: Singh
mesh_terms: D000141:Acidosis, Renal Tubular / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000150:complications / Q000188:drug therapy; D011188:Potassium / Q000627:therapeutic use; D011782:Quadriplegia / Q000209:etiology*; D013256:Steroids / Q000627:therapeutic use
chemical_list: D018501:Antirheumatic Agents; D013256:Steroids; D011188:Potassium