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Hypokalaemic quadriparesis in a patient with urinary diversion through Indiana pouch
  1. Srinivasa Anurag Kuchulakanti1 and
  2. Pradeep M Shenoy2
  1. 1General Medicine, KS Hegde Medical Academy, Mangalore, Karnataka, India
  2. 2Nephrology, KS Hegde Medical Academy, Mangalore, Karnataka, India
  1. Correspondence to Dr Srinivasa Anurag Kuchulakanti; anuragkuchulakanti{at}


A man in his 20s, a patient with chronic kidney disease with a baseline estimated glomerular filtration rate of 33 mL/min/1.73 m2, who had an Indiana pouch continent urinary diversion procedure done at 6 years of age for bladder exstrophy, presented to the emergency room with sudden-onset progressive quadriparesis over 6 hours with power 1/5 in all the limbs with preserved reflexes. He was fully conscious and oriented, with stable vital signs. On evaluation, he had severe hypokalaemia and severe metabolic acidosis (both high anion gap and non-anion gap acidosis). Imaging studies showed bilateral gross hydroureteronephrosis, and renal and pouch calculi. Hypokalaemia was promptly treated with intravenous potassium chloride and acidosis with emergency haemodialysis. The patient had a complete motor recovery following intravenous potassium correction and was discharged with oral potassium and bicarbonate supplements. Here, the Indiana pouch, its metabolic and electrolyte complications, and its treatment are discussed.

  • Fluid electrolyte and acid-base disturbances
  • Urological surgery
  • Chronic renal failure
  • Dialysis

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  • Contributors Dr.Anurag Kuchulakanti is a postgraduate in the department of general medicine, and Dr.Pradeep M Shenoy is a chief consultant and head of the unit in the department of nephrology. The patient in this case report was admitted under PMS and AK carried out the treatment plans after discussing with PMS. It was PMS idea to submit this case as a case report. AK followed through with the idea and did the data collection, data analysis, drafting of the article. PMS contributed to the critical revision of the article and final approval of the version to be uploaded. The British Medical Journal was selected by AK for the publication of this case report as it provides clinicians across the globe the clinical information about this interesting case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.