We present the case of a 39 year-old woman who was transferred to our emergency department with quadriplegia of recent onset. During clinical examination the patient fell into respiratory arrest and received ventilatory mechanical assistance. The laboratory evaluation showed severe hypokalemia and metabolic acidosis. Renal tubular acidosis type I was diagnosed. The patient received bicarbonate and potassium supplementation and all clinical symptoms improved. Respiratory arrest as a renal tubular acidosis type I manifestation is rare but it has an excellent prognosis if promptly diagnosed and treated. Pneumon 2006,19(2):137-140.