Renal tubular acidosis with severe hypokalaemic tetraparesis after intake of ibuprofen

History:A 72-year-old woman was admitted because of severe acute tetrapares is, more marked proximally. For six months she had been taking ibuprofen, u p to 4800 mg daily, for a painful ulcer of the lower leg. Investigations: Biochemical tests revealed marked hypokalaemia (serum potas sium 1,4 mmol/l) with a metabolic acidosis (pH 7.29). The ECC showed change s of hypokalaemia (ST-segment depression and U wave). Treatment and course: Within two days of administering potassium and bicarb onate the pareses completely regressed. Transitorily abnormal renal functio ns 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 ca use renal dysfunctions with life-threatening electrolyte abnormalities.