# Severe Hypokalemic Paralysis Unmasking Renal Tubular Acidosis in a Patient With Sjögren’s Syndrome

## TL;DR

A woman with Sjögren’s syndrome experienced severe muscle paralysis due to low potassium from kidney issues, which improved with intensive treatment.

## Contribution

This case highlights HPP as a rare but critical manifestation of SS-related RTA requiring urgent care.

## Key findings

- Acute hypokalemic paralysis occurred in a patient with Sjögren’s syndrome due to distal RTA.
- Central potassium and bicarbonate replacement led to significant clinical improvement.
- Early recognition and multidisciplinary care are crucial to prevent relapse and improve outcomes.

## Abstract

Hypokalemic periodic paralysis (HPP) is a rare but life-threatening complication in patients with Sjögren’s syndrome (SS), often due to distal renal tubular acidosis (RTA) caused by autoimmune-mediated renal damage. We report a case of a woman in her 30s with a history of rheumatoid arthritis and SS who presented with acute, flaccid paralysis secondary to profound hypokalemia from distal RTA, requiring intensive care support. This patient was treated with central potassium and bicarbonate replacement, leading to marked clinical improvement. This report emphasizes the importance of early recognition of HPP as a manifestation of SS-related RTA and underscores why multidisciplinary management and active long-term follow-up are essential to prevent relapse and optimize patient outcomes.