Potassium pause: a case of cardiac arrest unmasking distal renal tubular acidosis

Abstract Background Distal renal tubular acidosis (dRTA) is an uncommon renal tubular disorder disorder marked by impaired distal nephron acid excretion, resulting in hyperchloremic metabolic acidosis, persistent alkaline urine, and significant potassium loss. Complications include growth failure and rickets in children, whereas in adults osteomalacia, polyuria, nephrocalcinosis and nephrolithiasis are common. Hypokalaemia an invariable feature presents depending on severity. Muscular weakness, proximal myopathy and quadriparesis in severe cases can be the presentations. Severe hypokalaemia may rarely precipitate life-threatening cardiac arrhythmias including cardiac arrest. Case : We describe a 37-year-old male who presented with acute quadriparesis due to severe hypokalaemia. While attempts at potassium correctio were underway he had a cardiac arrest due to profound hypokalaemia. There were five such episodes over a span of 45 minutes, each followed by successful resuscitation. Once stabilised and the potassium climbed to safe levels, a metabolic evaluation confirmed dRTA. Timely recognition and targeted electrolyte correction ensured full recovery. Conclusion Hypokalaemia is not common and is easily managed with oral or parenteral potassium therapy. Repeated cardiac arrest due to hypokalaemia is the highlight of this case and emphasises the need for prompt identification of dRTA to prevent fatal complications in recurrences.