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Dysautonomia and hyponatraemia as harbingers of Guillain-Barre syndrome
  1. Preet Mukesh Shah1,
  2. Vijay Waman Dhakre2,
  3. Ramya Veerasuri1 and
  4. Anand Bhabhor1
  1. 1 Department of Critical Care, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
  2. 2 Department of HPB Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
  1. Correspondence to Dr Preet Mukesh Shah, drpreetshah{at}


A 56-year-old woman with a medical history of hypertension presented to our hospital with back pain, abdominal pain, vomiting and elevated blood pressure. The laboratory parameters including evaluation for secondary hypertension were within normal ranges at the time of presentation. During her hospitalisation, fluctuations in her blood pressure and pulse were observed which were attributed to autonomic disturbances, the cause of which was unknown. On the seventh day after presentation to the hospital, the patient developed focal seizures and slurred speech which was believed to be secondary to hyponatraemia detected at that time. Hyponatraemia improved with hypertonic saline and she experienced no further seizures. On the eighth day of her admission, she developed acute flaccid paralysis of all her limbs and respiratory distress. We concluded this to be secondary to Guillain-Barre syndrome (GBS). She responded to plasmapheresis.

The presence of dysautonomia and hyponatraemia before the onset of paralysis makes this a rare presentation of GBS.

  • hypertension
  • neurology (drugs and medicines)
  • peripheral nerve disease
  • fluid electrolyte and acid–base disturbances

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  • Contributors RV wrote up the case history. PMS wrote the discussion of the case and acquired the clinical images. AB and VWD assisted in the discussion of the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.