Zonisamide-induced distal renal tubular acidosis and critical hypokalaemia.

Thomas MacMahon, Yvelynne P Kelly

BMJ case reports 2023 Apr 11

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A woman in her 20s presented with rapidly progressive muscle weakness and a 1-month preceding history of fatigability, nausea and vomiting. She was found to have critical hypokalaemia (K+ 1.8 mmol/L), a prolonged corrected QT interval (581 ms) and a normal anion gap metabolic acidosis (pH 7.15) due to zonisamide-induced distal (type 1) renal tubular acidosis. She was admitted to the intensive care unit for potassium replacement and alkali therapy. Clinical and biochemical improvement ensued, and she was discharged after a 27-day inpatient stay. © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.