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1. 摘要題目:
以抗利尿激素不適當分泌症候群為初步表現的急性脫髓鞘性神經炎併
發急性呼吸衰竭
A case of Guillain Barre syndrome with initial presentation of SIADH,
complicated with acute respiratory failure
2.作者: 謝忠霖 Chung-Lin Hsieh1, 葉宏傑 Hung-Chieh Yeh1, 陳碩爵 Shuo-Chueh
Chen2
3.服務單位:
1
The Kidney Institute and Division of Nephrology, China Medical University Hospital,
Taichung, 台中中國醫藥大學附設醫院腎臟科暨腎臟醫學中心
2
Departments of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine,
China Medical University Hospital, Taichung
台中中國醫藥大學附設醫院內科部胸腔重症科
4.內文:
A 67-year-old man with history of hypertension, hyperlipidemia and left carotid
artery stenosis status post PTA with stenting presented with progressive weakness for 2
days.
Initially, he had productive cough, sorethroat and general muscle soreness since one
week ago. Two days later, progressive numbness in four limbs was noted along with
generalized weakness. One day before this admission, lower limbs weakness aggravated
that he could not get up from the bed. He was sent to ER, where initial vital signs was
stable. Physical examination revealed clear consciousness, glove-stocking sensory
deficit, paresthesia, decrease vibration in distal four limbs and decreased muscle power
in four limbs. Biochemistry panel revealed hypoosmolar hyponatremia with high urine
osmolality and sodium excretion. Thyroid and adrenal function tests were within normal
limit. Under the diagnosis of SIADH and possible sensorimotor polyneuropathy, he was
admitted for further care
Free water restriction and high salt diet were prescribed for hyponatremia. However,
one day after admission, severe respiratory distress with wheezing developed, which
was followed by desaturation. He was intubated and transferred to ICU.
Under the suspicion of Guillain-Barré syndrome (GBS), lumbar puncture was
performed and CSF study showed mild pleocytosis with significant high CSF protein.
Plasma exchange was performed for 5 sessions. Hyponatremia was also corrected. The
patient’s muscle power improved and limbs numbness ameliorated. With good weaning
index, he was extubated smoothly on 6th day of ICU stay.
We concluded that SIADH could be an early phenomenon of GBS. Patient with GBS
complicated with SIADH may still have favorable outcome after managing with plasma
exchange.
5.中英文 Key word: syndrome of inappropriate secretion of antidiuretic hormone,
plasma exchange, Guillain Barre syndrome, respiratory failure