Guillain-Barre Syndrome and its Prognosis with Hyponatremia

Guillain Barre Syndrome (GBS) can be described as a collection of clinical syndrome that manifest as an acute inflammatory polyradiculopathy with resultant weakness and diminished reflexes. The hyponatremia is a recognized association of GBS and is also known to occur after the administration of intravenous infusion of gamma globulin (WIG); a treatment often used in management of GBS. Hyponatremia in GBS is very often overlooked entity even though it is well established. The purpose of this study was to document serum sodium concentration in GBS patients before and during management procedures (including IVIG), positive pressure ventilation (PPV) and to assess whether hyponatremia is a predictor of poor outcome. Methodology: All patients (>2 years of age) diagnosed as Guillain-Barre Syndrome (GBS) fulfilling the criteria as modified by Asbury, admitted in the Medicine and Pediatric department of RNT Medical College and Associated Hospital, Udaipur from January 2014 to July 2015 were included in this study. After obtaining clinical history, electrophysiologic studies were performed to determine the GBS subtype. Serum electrolytes were determined at the time of admission of patient and during course of treatment (day 1 and day 3). Results: A total of 50 patients were studied. Male preponderance was observed with the maximum number (38.00%) of patients below 16 years age group and was seen in the months of April to June. All patients received physiotherapy and the nine patients who developed respiratory failure were put on mechanical ventilation. Six patients required mechanical ventilation inspite of intravenous immunoglobulin (IVIG) therapy. Eight patients received intravenous methylprednisolone (MPS). The mean duration of hospitalization was 8.66 days. Bulbar weakness and need for ventilatory support were higher in GBS with hyponatremia (6 v/s 3). Serum sodium concentration was low (<135 mmol/L] in 12 out of 50 (24.0%) patients. Eight of them had mild hyponatremia, three patients had moderate hyponatremia, and one patient had severe hyponatremia. Out of 50 patients of GBS, nine patients required mechanical ventilation. Conclusion: Hyponatremia has significant association with severity of GBS and is an indicator ofpoor prognosis. Hyponatremic patients have a poorer prognosis than eunatremic patients. In GBS, hydroelectrolytic disorders, especially hyponatremia, are processes that mark the prognosis and severity of the disease and must be identified early. Plasma sodium concentrations should be carefully monitored. In the Guillain-Barre syndrome a 'normal' intake of water may prove fatal.