Cause of respiratory paralysis: kidney, not the lung

Hypokalemia is a common electrolyte abnormality and if neglected, it may be fatal. This type of electrolyte abnormality is seen in distal renal tubular acidosis (RTA). Respiratory paralysis in distal RTA due to hyokalemia is a rare clinical entity described in the literature. Here we discuss one such case: a 25-year-old female presented with complaints of acute onset symmetrical weakness of bilateral lower limbs that rapidly progressed to involve trunk, upper limb and neck. Later on, she developed respiratory paralysis and was put on mechanical ventilation. Diagnosis of distal RTA with hypokalemia was made and managed successfully.