Renal tubular acidosis with severe hypokalaemic tetraparesis after intake of ibuprofen

History:A 72-year-old woman was admitted because of severe acute tetraparesis, more marked proximally. For six months she had been taking ibuprofen, up to 4800 mg daily, for a painful ulcer of the lower leg. Investigations: Biochemical tests revealed marked hypokalaemia (serum potassium 1,4 mmol/l) with a metabolic acidosis (pH 7.29). The ECC showed changes of hypokalaemia (ST-segment depression and U wave). Treatment and course: Within two days of administering potassium and bicarbonate the pareses completely regressed. Transitorily abnormal renal functions also rapidly normalized after ibuprofen had been discontinued. Conclusion: The biochemical findings suggest renal tubular acidosis, type 2, most likely caused by the excess intake of ibuprofen, a drug which can cause renal dysfunctions with life-threatening electrolyte abnormalities.