Sjogren's Syndrome Manifested as Hypokalemic Paralysis

A 31-year old woman was admitted for hypokalemic paralysis. Laboratory examination revealed hyperchloremic metabolic acidosis with a positive urinary anion gap compatible with distal renal tubular acidosis (DRTA). Her sicca symptom, as well as positive autoimmune studies pointed to the underlying cause as a case of Sjogren's syndrome. The complications of DRTA include life threatening hypokalemia, nephrolithiasis, chronic renal failure, growth retardation and osteomalacia. These co-morbidities can be avoided if the diagnosis is made early and life long potassium alkali salt replacement is maintained.