QUADRIPARESIS IN SJOGREN SYNDROME

Abstract

Hypokalemic paralysis is a well recognised clinical presentation of Primary sjogren syndrome that occurs due to renal potassium loss caused by interstitial nephritis. However we report a case where a hypokalemic paralysis in a suspected case of sjogren syndrome was associated with high anion gap metabolic acidosis in the presence of a near normal Glomerular filtration rate (RTA) and a failure to acidify urine pH< 5.5 .Such cases represent a minority of distal RTA patients as they characteristically present with an elevated anion gap due to an often unidentified systemic acid load which has lead to precipitation of Renal tubular acidosis and consequent urinary potassium loss and an added metabolic acidosis. The diagnosis often gets delayed due to an elevated anion gap nature of metabolic acidosis but is usually confirmed by hypercalciuria and urine pH > 5.5 in the presence of systemic acidosis.