Distal renal tubular acidosis (dRTA) is a rare disorder characterized by impaired acid excretion leading to metabolic acidosis and hypokalemia. Its occurrence during pregnancy, particularly alongside systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), poses significant challenges for both maternal and fetal outcomes. This case report describes the successful management of a 23-year-old woman with secondary dRTA, SLE, and APS during pregnancy. The patient, with a history of recurrent hypokalemia and previous preterm deliveries, was closely monitored by a multidisciplinary team. Throughout her pregnancy, she required significant potassium and bicarbonate supplementation to maintain electrolyte and acid-base balance. Additionally, hydroxychloroquine, methylprednisolone, aspirin, and unfractionated heparin were continued to manage SLE and APS. Despite the complexity of her condition, she delivered a healthy baby girl at 37 weeks via cesarean section. This case provides valuable insights into managing dRTA during pregnancy, highlighting the importance of customized approaches to the management of electrolyte and acid-base abnormalities, as well as that of autoimmune disease.