A case of severe metabolic acidosis during pregnancy

A Case of Recurrent Gestational Hypokalemia Due to an Exaggerated Physiological Response to Pregnancy: The Importance of Using Pregnancy-Specific Reference Ranges

Hypokalemia in pregnancy can occur secondary to hemodilution of pregnancy, physiological changes during pregnancy, or other pathological conditions. It should be investigated the same way as in non-pregnancy with particular emphasis on the importance of using pregnancy-specific reference ranges when interpreting clinical laboratory test results. Here, we present a case of a woman who had late-trimester gestational hypokalemia requiring potassium supplementation affecting four consecutive pregnancies. We thought that there was accompanying hypomagnesemia and hypobicarbonatemia in previous pregnancies, so we suspected a form of renal tubular dysfunction exacerbated by pregnancy. Subsequent investigation and the use of pregnancy-specific reference ranges revealed that this was an exaggerated physiological response to pregnancy.

A Case Report of Paralysis and Respiratory Difficulty in a Patient With a Recent History of Complicated Pregnancy - An Uncommon Expression of Distal Renal Tubular Acidosis

Renal tubular acidosis type 1 (RTA-1) is a disorder where kidneys are unable to acidify urine, which ultimately results in normal anion gap metabolic acidosis. Its initial presentations and subsequent clinical manifestations can vary depending on the underlying cause and severity of the disease. We report a case of a 26-year-old female with a recent history of complicated pregnancy. She presented to a tertiary care hospital with quadriplegia and shortness of breath and required ventilator support. The extensive workup revealed that the patient had RTA-1 in association with Sjögren's syndrome. There are only a few cases of RTA-1 reported where the diagnosis was made during the pregnancy. By reporting this case of RTA-1 with rare initial clinical presentation and a recent complicated pregnancy, we propose that further research studies should be carried out in this area to explore a possible statistically significant association between pregnancy (and its complications) and RTA-1 exacerbation.

Incomplete distal renal tubular acidosis uncovered during pregnancy: A case report

BACKGROUND

Renal tubular acidosis (RTA) is a renal cause of non-anion-gap metabolic acidosis characterized by low urinary ammonia excretion. This condition has a low prevalence, and various congenital and acquired etiologies. To date, only a few cases of idiopathic RTA uncovered during pregnancy have been reported.

CASE SUMMARY

A previously healthy 32-year-old Korean woman at 30 wk of gestation was admitted to Pusan National University Hospital with preterm labor. At admission, the patient presented with hypokalemia, non-anion-gap metabolic acidosis, and nephrocalcinosis. Distal RTA was diagnosed based on laboratory blood and urine findings and imaging examinations. Various tests, including next-generation gene sequencing panels for nephropathy, were performed to determine the etiology of the disease, which indicated that it was idiopathic. The patient received sodium bicarbonate and potassium chloride supplementation. After 3 wk, she delivered a baby who was subsequently diagnosed with corpus callosum agenesis and colpocephaly. During regular follow-ups for 6 mo postpartum, her hypokalemia and metabolic acidosis were gradually resolved, and medications eventually discontinued.

CONCLUSION

Herein we describe a case of idiopathic distal RTA discovered during pregnancy. Hypokalemia and metabolic acidosis resolved spontaneously after delivery.