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Background Distal renal tubular acidosis (dRTA) is the most common type of renal tubular acidosis (RTA) in children. Pediatric dRTA is usually genetic and rarely occurs due to acquired issues such as obstructive uropathies, recurrent urinary tract infections (UTIs), and chronic kidney disease (CKD). Although persistent hypokalemia frequently occurs with dRTA, acute hypokalemic paralysis is not frequently reported, especially in older children. Case presentation An eight-year-old girl presented with an acute first episode of paralysis. A physical examination revealed normal vital signs, short stature consistent with her genetic potential, and decreased muscle strength of her upper and lower extremities. Preexisting conditions included stage 4 CKD due to recurrent UTIs, severe vesicoureteral reflux and bilateral hydronephrosis, neurogenic bladder, and multisegment thoracic syringomyelia. Her laboratory work-up revealed hypokalemic, hyperchloremic metabolic acidosis with a normal anion gap. She also had a urine osmolal gap of 1.9 mOsmol/kg with a high urine pH. Intravenous potassium replacement resulted in a complete resolution of her paralysis. She was diagnosed with dRTA and discharged with oral bicarbonate and slow-release potassium supplementation. Conclusions This case report highlights the importance of considering dRTA in the differential diagnosis of hypokalemic acute paralysis in children. Additionally, in children with neurogenic lower urinary tract dysfunction and recurrent UTIs, early diagnosis of spinal cord etiology is crucial to treat promptly, slow the progression of CKD, and prevent long-term complications such as RTA.

Diet with high fructose and cholesterol (HFHC) plays a role in the increasing incidence of diabetes mellitus and metabolic syndrome. Ethanol extract from Acalypha indica has been known to alleviate hyperglycemia and hyperuricemic conditions in rats induced by substances that destroy beta cells. This research aimed to evaluate its effect in rats induced by diet. Male Sprague-Dawley rats were divided into seven groups, six of which are given HFHC diet for 1,5 months. In the following month, rats were given therapy while diet continued. Therapy consisted of 250 mg/kg BW/day of Acalypha indica Linn. root’s ethanol extract, 100 mg/kgBW/day of metformin, 30mg/kg BW/day of allopurinol, or combination. Lowest blood glucose value was found in group receiving both AI and metformin. No significant difference was found between pre- and post- therapy blood glucose in groups treated with AI (p=0,831), metformin (p=0,056), or both (p=0,908). Uric acid level was increased in all groups, with highest rate found in group receiving both allopurinol and AI. The difference in uric acid level between treatment group was 0.331. Whilst insignificant, ethanolic extract of Acalypha indica Linn. was observed to lower blood glucose in rats. Group treated with AI showed similar rise in uric acid level, with combination therapy showed highest rise. Further research with longer duration of induction and therapy will be required to better understand the hypoglycemic and antihyperuricemic effects exerted by AI.