Both RTA and T1DM have been associated with autoimmunity but they have been reported together rarely.
A 23-year-old female presented with DKA persisted to have acidosis after normalization of sugars. She was diagnosed with concurrent RTA on urine analysis without any underlying cause. The simultaneous occurrence of these two conditions is challenging because of the need for bicarbonate therapy in RTA; and its relative contraindication in DKA. Management of hypokalemia also becomes challenging in this condition.
Both RTA and DKA have a similar clinical presentation and, therefore, require a higher degree of clinical suspicion, especially in cases of non-resolving acidosis.
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Agarwal, K., Thakur, D. & Gupta, A. Concomitant diabetic ketocacidosis and renal tubular acidosis in a type 1 diabetes mellitus patient. Int J Diabetes Dev Ctries 41, 172–174 (2021). https://doi.org/10.1007/s13410-020-00856-x