Key result
A critically ill cat with severe hypokalemia and suspected distal renal tubular acidosis was successfully managed in the ICU, documenting a rare mineralocorticoid response.
Case Report (n=1)
This is the first reported case of distal renal tubular acidosis with a simultaneously documented mineralocorticoid response causing life-threatening hypokalemia in a cat.
May prompt DRTA evaluation in hypokalemic cats with normal-gap acidosis; leaves open validation of secondary hyperaldosteronism and management strategies.
OBJECTIVE: Description of the clinical presentation and management of a critically ill cat with profound hypokalemia associated with a suspicion of distal renal tubular acidosis (DRTA) and secondary hyperaldosteronism. CASE SUMMARY: A cat was presented with severe generalized weakness and acute ventilatory failure associated with severe hypokalemia. The acid-base analysis and complete analytical profile of the urine confirmed the presence of a normal anion-gap metabolic acidosis with a urine pH of 7, a disorder consistent with DRTA. The high plasma renin activity, high aldosterone concentration, and low normal plasma aldosterone concentration/plasma renin activity ratio suggested secondary hyperaldosteronism. The management of the patient in the ICU was successful. No identifiable cause could be determined as a cause for the DRTA, so the disorder was assumed to be the primary problem. NEW OR UNIQUE INFORMATION PROVIDED: DRTA is a rare disorder occasionally reported in the veterinary literature; it is especially rare in cats. Complete diagnostic evaluation was necessary to identify the reported disorders as the cause of the clinical presentation. To the author's knowledge, this is the first case reporting DRTA, and a simultaneously documented mineralocorticoid response, as a cause of a life-threatening hypokalemia.
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Torrente et al. (2009) conducted a case report in Severe life-threatening hypokalemia and suspected distal renal tubular acidosis (n=1). Intensive care unit management was evaluated on Clinical recovery. A critically ill cat with severe hypokalemia and suspected distal renal tubular acidosis was successfully managed in the ICU, documenting a rare mineralocorticoid response.
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