A 23-Year-Old Unaware She’s Pregnant With Hematuria, ECG Abnormalities
A 23-year-old woman presents to the emergency department with a 3-day history of progressively worsening generalized muscle weakness and nonbilious emesis. She has been vomiting once or twice daily, mostly upon awakening. The emesis does not seem to be associated with oral intake. She is also experiencing intermittent hematuria, without any flank pain or dysuria. She denies having fever, diarrhea, chills, headache, abdominal pain, visual disturbances, or paresthesias. Before the onset of symptoms, the patient was in good health, with a medical history significant only for renal colic 8 months before presentation. She had cosmetic rhinoplasty 2 years ago but otherwise has not had any prior major surgery. She has no known allergies and is not taking any medications. Her last menstrual period was 1 month ago. Results of a urine pregnancy test result are positive.
@ayan Distal renal tubular acidosis (RTA) was diagnosed on the basis of the patient's presentation of profound weakness, history of renal colic, ECG findings consistent with severe hypokalemia, renal ultrasound showing nephrocalcinosis, and arterial blood gas analysis showing profound metabolic acidosis.