A 19-year-old female presented to ED with one day history of limb paralysis. She had bilateral muscular cramping in her upper and lower extremities that progressed to profound weakness on the morning of admission. She had a similar episode five years prior that resulted in a diagnosis of hypokalemic periodic paralysis. She was prescribed oral potassium supplementation, which she took for four months before self-discontinuing. On presentation to the emergency department, physical examination revealed 0/5 strength in bilateral upper and lower extremities. No sensory deficits were noted. Reflexes were 2+ throughout. Labs revealed potassium of 1.9, chloride of 121, bicarbonate of 8, magnesium of 2.7, and phosphorus of 1.9. Initial IV and oral potassium supplementation in the emergency department improved the potassium level to 2.2. Muscle cramps returned in all four extremities. Strength improved to 3/5 in all extremities. Her 24-hour urine significant for potassium of 117 and chloride of 177 with a positive urinary anion gap. Renal ultrasonography was significant for bilateral renal stones. Her labs and symptoms improved with treatment; she was diagnosed with RTA Type 1 and was discharged on oral potassium and bicarbonate supplementation. Hypokalemia is a common occurrence with type I RTA. However, paralysis of upper and lower extremities has not been previously reported.
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