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幾天前收進來的一個病人，85 y/r old p/w worsening general weakness expecially LE weakness.[Na] at 118 on admission. 病人幾天前抱怨腳痛，還有惡心感。初步診斷為hyponatremia. volum depletion vs SIADH.H and P r/o volume depletion or volume overload. But BUN/Crea>20, Hgb at 15, urine Na <10 支持 volumn depletion。於是我們給病人NS at 100cc/hr.Avoid rapid correction of Na.三天之內沒有明顯改觀。TSH WNL。Cortisol level is still pending.Urine Na later on WNL。腎內基本上開始支持SIADH.認為起初是mixture picture.但是好玩的是病人昨天[Na] at 112 with AMS 並且報告自己兩邊下肢上行性worsening weakness and loss of sensation and start to have urine incontinence. PE reveals a loss of DTR.好嗎，？Guillain Barre syndrome.Neuro consult right away.神經內科一來，ICU team就給叫來assess 病人，馬上給了 IVIG treatment。連LP也沒做。而且還指出Guillain Barre syndrome 可以產生hyponatremia。我跟ICU的senior雖然都報懷疑態度，但畢竟排除危險的疾病先。Guillain Barre syndrome will cause respiratory failure.一分鍾都不能耽誤的。
有興趣的朋友可以看了我的帖子探討一下。
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