Hyperkalaemic distal renal tubular acidosis secondary to tacrolimus

Hyperkalaemia can be a problem post transplant. There are many causes to consider. In this case the notable features are a hyperkalaemia associated with a metabolic acidosis but without evidence of renal failure, lactic acidosis or haemolysis. The patient was notably diabetic. Although enoxaparin can rarely be associated with hyperkalaemia, the presence of risk factors, a metabolic acidosis, and an inappropriately low urine pH is more in keeping with a distal renal tubular acidosis. Tacrolimus has been well described to cause this.