几天前收进来的一个病人，85 y/r old p/w worsening general weakness expecially LE weakness.[Na] at 118 on admission. 病人几天前抱怨脚痛，还有恶心感。初步诊断为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。于是我们给病人NS at 100cc/hr.Avoid rapid correction of Na.三天之内没有明显改观。TSH WNL。Cortisol level is still pending.Urine Na later on WNL。肾内基本上开始支持SIADH.认为起初是mixture picture.但是好玩的是病人昨天[Na] at 112 with AMS 并且报告自己两边下肢上行性worsening weakness and loss of sensation and start to have urine incontinence. PE reveals a loss of DTR.好吗，？Guillain Barre syndrome.Neuro consult right away.神经内科一来，ICU team就给叫来assess 病人，马上给了 IVIG treatment。连LP也没做。而且还指出Guillain Barre syndrome 可以产生hyponatremia。我跟ICU的senior虽然都报怀疑态度，但毕竟排除危险的疾病先。Guillain Barre syndrome will cause respiratory failure.一分钟都不能耽误的。
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