Hipokalaemic tetraparesis: renal etiology elucidated by strong ion difference calculation

N. Hagău1, S. Cocu2, M. Mleşniţe3, R. Găvruş2, C. Bădescu2, C. Laslo2, I. Geczi-Toth2, A. Bărăcan2

1) Universitatea de Medicină şi Farmacie „Iuliu Haţieganu”
2) Secţia ATI nr.1, Spitalul Clinic Judeţean de Urgenţă, Cluj-Napoca

Abstract

The case of a 36 year old woman is presented. She was referred to our intensive care unit with acute muscle weakness and tetraparesis that had occurred after a bout of diarrhea and vomiting. On arrival in the unit she had a severe muscle weakness associated with life-threatening hipokalaemia. Acido-base and electrolytes balance were modified: plasmatic pH and plasma bicarbonate were decreased; plasma Cl- concentration was increased. Hyperchloremic metabolic acidosis and hipokalaemia were attributed to diarrhea and vomiting. Lactated Ringer’s solution was used instead of normal saline to replace gastrointestinal losses and KCl solution was infused. In spite of the therapy, the acidosis, hypokalaemia and hipercloremia did not change. The calculation of the plasma apparent SID and urine apparent SID was made for differential diagnosis of renal and non-renal tubular acidosis type I. The response to alkali and potassium replacement was good and she was referred to the Nephrology Department.
Key words: SID (strong ion difference), tubular acidosis, hipokalaemia

CAZURI CLINICE

Tetrapareza hipokalemică: etiologia renală elucidată prin calculul diferenţei ionilor puternici

Jurnalul Român de Anestezie Terapie intensivă 2007, Vol.14,