A Curious Case of Quadriplegia

Background: Hypokalemic periodic paralysis (HPP) is an uncommon disorder of the muscle marked by intermittent weakness of muscles , which, in severe cases, can progress to respiratory failure. It is frequently associated with renal tubular acidosis, a condition that can manifest in connection with systemic disorders like Sjögren’s syndrome and thyroid disorders.  Case Presentation: A 58-years-old woman presented to the hospital with weakness in all extremities. The patient exhibited motor strength of 0/5 in all limbs. The ECG revealed sinus bradycardia and hypokalemia changes. Laboratory tests showed hypokalemia, metabolic acidosis with a high anion gap, urine pH of more than 5.5, FT4 levels at 6.9 ng/dL, TSH levels at 25.03 IU/mL, Anti-TPO antibodies positive, and a positive SS-A (Ro), Ro-52, SS-B (La) in the ANA profile, indicative of Sjogren's syndrome. Patient has previously experienced similar issues and also has a confirmed diagnosis of hypothyroidism.  Discussion: The patient received diagnoses of hypokalemic periodic paralysis(HPP), Sjögren's syndrome, and renal tubular acidosis due to findings of hypokalemia, metabolic acidosis, elevated urine pH, and a positive ANA profile.  Conclusion: Distal renal tubular acidosis secondary to Sjögren’s syndrome can rarely present as HPP.