Daily Bolus of LR: Guillain-Barré

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February 7, 2011 by dailybolusoflr

Guillain-Barré Syndrome, a demyelinating polyneuropthy, often presents 1-2 weeks after an infectious illness.
Patients with Guillain-Barré Syndrome classically present with
·         Bilateral lower extremity weakness- greater distally than proximally and often with sparing of the anal sphincter
·         Deep tendon reflexes are often diminished or absent
·         Sensory changes can be variable
These patients are at risk for respiratory failure related to respiratory muscle weakness.
·         This is best predicted by a negative inspiratory force (NIF) of < 30 cm H20. 
·         An alternative measurement that can be used is forced vital capacity (FVC).  An FVC < 20 mL/kg is predictive of possible impending respiratory failure.
·         Arterial blood gas measurements can be used to evaluate for respiratory function by meansuring the pCO2. Elevations in pCO2 are indicative of alveolar hypoventilation and are associated with respiratory failure. There is no absolute pO2 which is predictive of respiratory failure.
The recommended treatments include plasma exchange or intravenous immunoglobulin. Steroids are no longer indicated.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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