ACUTE FLACCID PARALYSIS PRESENTING AS RENAL TUBULAR ACIDOSIS IN A CHILD: A CASE REPORT

Abstract

Background: Acute Flaccid Paralysis with symptoms of hypokalaemia and paralysis which was initially mistaken for the Guillain-Barre syndrome, however it was later diagnosed as Distal Renal Tubular Acidosis (dRTA). Renal tubular acidosis is a constellation of syndromes arising from different derangements of tubular acid transport. Common clinical presentations of dRTA in the paediatric age group include polyuria, nocturia, failure to thrive, constipation, abnormal breathing and nephrolithiasis. Though persistent hypokalemic is frequently seen in dRTA, hypokalemic muscular paralysis is uncommon and rarely described in children. Case presentation: A case of 4 years 6 months old male presented with chief complaints of unable to stand and walk, unable to sit, unable to hold his neck  since morning. Motor examination revealed weakness in the lower limbs with decrease in tone and power and absent deep tendon reflexes of the lower limbs. Blood investigations revealed hypokalaemia. An ABG was done 
which showed hyperchloremic normal anion gap metabolic acidosis, which raised the suspicion of renal tubular acidosis. Urine pH, urine anion gap and ultrasound abdomen pointed towards Distal Renal Tubular Acidosis. The child was treated accordingly and improved clinically. Conclusion: Whenever a child presents with weakness with neck drop, should  raise a  suspicion of  hypokalaemia, subsequent  ABG should be performed  to rule out  Renal Tubular Acidosis. This case highlights the importance of considering hypokalaemia and renal tubular acidosis in the differential diagnosis of acute flaccid paralysis.  Early diagnosis will prevent costly investigations and enable rapid clinical recovery in the affected child.