Chronic Liver Disease Primarily Presenting with Motor Weakness by Intractable Hypokalemia with Combined Respiratory Alkalosis and Chronic Diarrhea: A Case Report

We present a case of liver cirrhosis complicated by intractable hypokalemia, respiratory alkalosis, portal hypertension, and chronic diarrhea. A 24-h urine analysis showed renal excretion levels of Na⁺, K⁺, and Cl^- at 6.0, 2.5, and 11.0 mmol, respectively, suggesting renal retention of these electrolytes. Meanwhile, the serum levels of Na⁺, K⁺, and Cl^- were 136, 1.8, and 98 mEq/L, respectively, indicating a preserved balance of sodium and chloride but not potassium. This case underscores the importance of clinicians considering both liver cirrhosis-associated hypoxia and chronic liver disease-induced chronic diarrhea as potential underlying causes, especially when more common causes of hypokalemia have been excluded.