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Abstract: TH-PO345

Nephrogenic Diabetes Insipidus a Rare Complication of Renal Tubular Acidosis

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1001 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Basic


  • Rosario Aulet, Alexandra, Sistema de Salud Episcopal San Lucas, Ponce, Ponce, Puerto Rico
  • Miró Có, Adrián A., Hospital San Cristobal, Ponce, PR, Puerto Rico
  • Torres Cintron, Jose, Sistema de Salud Episcopal San Lucas, Ponce, Ponce, Puerto Rico

Hypokalemia is a common electrolyte disturbance, seen in hospitalized patient caused by either gastrointestinal or urinary losses. Although uncommon, the latter can occur due to renal tubular acidosis type 1 (RTA type 1), a disorder characterized by impaired distal tubular acidification leading to hypokalemia, nephrocalcinosis and recurrent renal stones. Severe hypokalemia, in turn, can lead to cardiac arrhythmias, weakness, paralysis, rhabdomyolysis, respiratory failure, and nephrogenic diabetes insipidus (DI).

Case Description

This is the case of a 50-year-old Hispanic female patient with a past medical history of systemic lupus erythematosus, lupus nephritis by kidney biopsy (type V membranous), chronic kidney disease stage G1/A3, nephrolithiasis, hypertension, and diabetes mellitus type 2 who presented to the emergency department due to a progressive flaccid paralysis ultimately requiring intubation for airway protection. Her laboratory work up was remarkable for severe hypokalemia (1.5mmol/L), hyperchloremia (128.70mmol/L), metabolic acidosis (pH:7.2), urinary alkalosis (pH of 7.0) and a positive urinary anion gap (37mmol/L), all compatible with the diagnosis of RTA type 1. Despite efforts to improve hypokalemia, patient’s potassium levels remained critically low and she developed polyuria (5.5 L/day) which in turn resulted in severe hypernatremia. The diagnosis of nephrogenic DI mas made, and the patient was treated with amiloride, aggressive intravenous fluid and electrolyte replacements. Eventually, with complete resolution of symptoms and plans of discharge.


Nephrogenic DI is an uncommon complication of RTA type 1, triggered by severe electrolyte disturbances, in this case severe hypokalemia. Treatment of choice for Nephrogenic DI would be hydrochlorothiazide, but taking into account patients prevalent severe hypokalemia amiloride was prescribed. We want to bring into light the importance of diagnosing and treating of severe electrolyte disturbances to avoid severe complications as seen in nephrogenic DI, as seen in this patient.