Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride
A 28-year-old female with history of hypothyroidism, Sjögren’s Syndrome, and Systemic Lupus Erythematosus (SLE) presented with complaints of severe generalized weakness, muscle pain, nausea, vomiting, and anorexia. Physical examination was unremarkable. Laboratory test showed hypokalemia at 1.6 mmol...
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Wiley
2017-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2017/8596169 |
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| author | Patrick Oguejiofor Robert Chow Kenneth Yim Bernard G. Jaar |
| author_facet | Patrick Oguejiofor Robert Chow Kenneth Yim Bernard G. Jaar |
| author_sort | Patrick Oguejiofor |
| collection | DOAJ |
| description | A 28-year-old female with history of hypothyroidism, Sjögren’s Syndrome, and Systemic Lupus Erythematosus (SLE) presented with complaints of severe generalized weakness, muscle pain, nausea, vomiting, and anorexia. Physical examination was unremarkable. Laboratory test showed hypokalemia at 1.6 mmol/l, nonanion metabolic acidosis with HCO3 of 11 mmol/l, random urine pH of 7.0, and urine anion gap of 8 mmol/l. CT scan of the abdomen revealed bilateral nephrocalcinosis. A diagnosis of type 1 RTA likely secondary to Sjögren’s Syndrome was made. She was started on citric acid potassium citrate with escalating dosages to a maximum dose of 60 mEq daily and potassium chloride over 5 years without significant improvement in serum K+ and HCO3 levels. She had multiple emergency room visits for persistent muscle pain, generalized weakness, and cardiac arrhythmias. Citric acid potassium citrate was then replaced with sodium bicarbonate at 15.5 mEq every 6 hours which was continued for 2 years without significant improvement in her symptoms and electrolytes. Amiloride 5 mg daily was added to her regimen as a potassium sparing treatment with dramatic improvement in her symptoms and electrolyte levels (as shown in the figures). Amiloride was increased to 10 mg daily and potassium supplementation was discontinued without affecting her electrolytes. Her sodium bicarbonate was weaned to 7.7 mEq daily. |
| format | Article |
| id | doaj-art-6781923aadd34883a503d7fbfd1d2137 |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-6781923aadd34883a503d7fbfd1d21372025-02-03T06:01:19ZengWileyCase Reports in Nephrology2090-66412090-665X2017-01-01201710.1155/2017/85961698596169Successful Management of Refractory Type 1 Renal Tubular Acidosis with AmiloridePatrick Oguejiofor0Robert Chow1Kenneth Yim2Bernard G. Jaar3Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USADepartment of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USADivision of Nephrology, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USADepartment of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USAA 28-year-old female with history of hypothyroidism, Sjögren’s Syndrome, and Systemic Lupus Erythematosus (SLE) presented with complaints of severe generalized weakness, muscle pain, nausea, vomiting, and anorexia. Physical examination was unremarkable. Laboratory test showed hypokalemia at 1.6 mmol/l, nonanion metabolic acidosis with HCO3 of 11 mmol/l, random urine pH of 7.0, and urine anion gap of 8 mmol/l. CT scan of the abdomen revealed bilateral nephrocalcinosis. A diagnosis of type 1 RTA likely secondary to Sjögren’s Syndrome was made. She was started on citric acid potassium citrate with escalating dosages to a maximum dose of 60 mEq daily and potassium chloride over 5 years without significant improvement in serum K+ and HCO3 levels. She had multiple emergency room visits for persistent muscle pain, generalized weakness, and cardiac arrhythmias. Citric acid potassium citrate was then replaced with sodium bicarbonate at 15.5 mEq every 6 hours which was continued for 2 years without significant improvement in her symptoms and electrolytes. Amiloride 5 mg daily was added to her regimen as a potassium sparing treatment with dramatic improvement in her symptoms and electrolyte levels (as shown in the figures). Amiloride was increased to 10 mg daily and potassium supplementation was discontinued without affecting her electrolytes. Her sodium bicarbonate was weaned to 7.7 mEq daily.http://dx.doi.org/10.1155/2017/8596169 |
| spellingShingle | Patrick Oguejiofor Robert Chow Kenneth Yim Bernard G. Jaar Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride Case Reports in Nephrology |
| title | Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride |
| title_full | Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride |
| title_fullStr | Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride |
| title_full_unstemmed | Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride |
| title_short | Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride |
| title_sort | successful management of refractory type 1 renal tubular acidosis with amiloride |
| url | http://dx.doi.org/10.1155/2017/8596169 |
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