Syndrome of inappropriate antidiuretic hormone as the initial presentation in Guillain-Barré syndrome

Divya Asti,Bindu Madhavi Mudduluru,Elie El-Charabaty,Jiyoung Wong,Nicholas Fuca

doi:10.15171/jnp.2018.42

Abstract

Background: Guillain-Barré syndrome (GBS) is an autoimmune disease damaging the peripheral nervous system. It commonly presents as rapidly progressing bilateral symmetrical motor weakness. There has been known association of syndrome of inappropriate antidiuretic hormone (SIADH) in patients with GBS though it is rare. Case Presentation: We report a patient with rare clinical presentation of SIADH before the onset of motor deficits in GBS. Conclusions: SIADH as an initial finding in patients with GBS is very rare. This case report emphasizes the importance of early detection of SIADH in GBS to avoid delay in treatment.

Highlights

Guillain-Barré syndrome (GBS) is an autoimmune disease damaging the peripheral nervous system
Case Presentation: We report a patient with rare clinical presentation of syndrome of inappropriate antidiuretic hormone (SIADH) before the onset of motor deficits in GBS
Implication for health policy/practice/research/medical education: Our case report emphasizes that SIADH could precede the development of profound motor deficit in patients with GuillainBarré syndrome

Summary

Background

Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in the United States with incidence of 1-2 cases per 100 000 patients [1,2]. Case Presentation A 72-year-old functionally independent female, presented with complaints of bilateral lower extremity weakness and difficulty ambulating She reports having numbness and tingling in bilateral feet, as well as nausea. The patient was placed on fluid restriction to 1L per day, and her serum sodium level continued to decline to 113 mEq/L, and intravenous hydration of 3% saline was initiated despite which her serum sodium continued to decline. She was later started on oral tolvaptan 15 mg daily for 7-days for management of SIADH. With aggressive treatment and inpatient physical therapy, patient regained her strength and was able to walk without assistance upon discharge

Findings

Discussion

Conclusions