Electrolyte imbalances and nephrocalcinosis in acute phosphate poisoning on chronic type 1 renal tubular acidosis due to Sjögren's syndrome

• Published in: Journal of Korean medical science Vol. 28; no. 2; pp. 336 - 339
• Main Authors: Cho, Sung-Gun, Yi, Joo-Hark, Han, Sang-Woong, Kim, Ho-Jung
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.02.2013; 대한의학회
• Subjects: Acidosis, Renal Tubular - diagnosis; Acidosis, Renal Tubular - etiology; Acute Disease; Adult; Antibodies, Antinuclear - blood; Calcium Gluconate - therapeutic use; Case Report; Chronic Disease; Female; Humans; Hydrogen-Ion Concentration; Hypocalcemia - chemically induced; Hypocalcemia - complications; Hypocalcemia - drug therapy; Nephrocalcinosis - complications; Nephrocalcinosis - diagnosis; Nephrocalcinosis - diagnostic imaging; Parotid Gland - diagnostic imaging; Phosphates - adverse effects; Radionuclide Imaging; Salivary Glands - diagnostic imaging; Sjogren's Syndrome - complications; Sjogren's Syndrome - diagnosis; Sjogren's Syndrome - metabolism; Submandibular Gland - diagnostic imaging; Ultrasonography; 의학일반; Sodium Phosphate; Nephrocalcinosis; Sjögren's Syndrome; Distal RTA; Hypocalcemia
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2013.28.2.336

Although renal calcium crystal deposits (nephrocalcinosis) may occur in acute phosphate poisoning as well as type 1 renal tubular acidosis (RTA), hyperphosphatemic hypocalcemia is common in the former while normocalcemic hypokalemia is typical in the latter. Here, as a unique coexistence of these two seperated clinical entities, we report a 30-yr-old woman presenting with carpal spasm related to hypocalcemia (ionized calcium of 1.90 mM/L) due to acute phosphate poisoning after oral sodium phosphate bowel preparation, which resolved rapidly after calcium gluconate intravenously. Subsequently, type 1 RTA due to Sjögren's syndrome was unveiled by sustained hypokalemia (3.3 to 3.4 mEq/L), persistent alkaline urine pH (> 6.0) despite metabolic acidosis, and medullary nephrocalcinosis. Through this case report, the differential points of nephrocalcinosis and electrolyte imbalances between them are discussed, and focused more on diagnostic tests and managements of type 1 RTA.