Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-06-09T08:57:59.424Z Has data issue: false hasContentIssue false

Hyponatremia in Guillain-Barre Syndrome: A Review of Its Pathophysiology and Management

Published online by Cambridge University Press:  16 February 2024

Archana B. Netto*
Affiliation:
Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
Niveditha Chandrahasa
Affiliation:
Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
Sheril S. Koshy
Affiliation:
Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
Arun B. Taly
Affiliation:
Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
*
Corresponding author: Archana B. Netto; Email: archananetto@yahoo.com

Abstract:

Guillain-Barre syndrome (GBS) is the commonest cause of acute polyradiculoneuropathy that requires hospitalization. Many of these patients experience systemic and disease-related complications during its course. Notable among them is hyponatremia. Though recognized for decades, the precise incidence, prevalence, and mechanism of hyponatremia in GBS are not well known. Hyponatremia in GBS patients is associated with more severe in-hospital disease course, prolonged hospitalization, higher mortality, increased costs, and a greater number of other complications in the hospital and worse functional status at 6 months and at 1 year. Though there are several reports of low sodium associated with GBS, many have not included the exact temporal relationship of sodium or its serial values during GBS thereby underestimating the exact incidence, prevalence, and magnitude of the problem. Early detection, close monitoring, and better understanding of the pathophysiology of hyponatremia have therapeutic implications. We review the complexities of the relationship between hyponatremia and GBS with regard to its pathophysiology and treatment.

Résumé :

RÉSUMÉ :

Hyponatrémie dans le cas du syndrome de Guillain-Barré : une analyse de sa physiopathologie et de sa prise en charge.

Le syndrome de Guillain-Barré (SGB) est la cause la plus fréquente de polyradiculoneuropathie aiguë nécessitant une hospitalisation. Plusieurs des patients atteints présentent des complications systémiques liées à une maladie au cours de l’évolution de ce syndrome. L’hyponatrémie est l’une de ces complications. Bien que reconnue depuis des décennies, l’incidence, la prévalence et le mécanisme précis de l’hyponatrémie dans le cas du SGB ne sont pas bien connus. On le sait, l’hyponatrémie chez les patients atteints de SGB est associée à une évolution plus sévère de ce syndrome à l’hôpital, à une hospitalisation prolongée, à une mortalité plus élevée, à des coûts accrus, à un plus grand nombre d’autres complications survenant à l’hôpital et à un état fonctionnel moins favorable au bout de six mois et d’un an. Bien que le manque de sodium ait été fréquemment associé au SGB, nombre d’études n’ont pas inclus la relation temporelle exacte du sodium ou ses valeurs sérielles dans le cas du SGB, sous-estimant ainsi l’incidence, la prévalence et l’ampleur exacte du problème. Une détection précoce, une surveillance étroite et une meilleure compréhension de la physiopathologie de l’hyponatrémie ont pourtant des implications thérapeutiques. Dans cet article, nous entendons donc passer en revue les complexités de la relation entre l’hyponatrémie et le SGB en ce qui concerne sa pathophysiologie et son traitement.

Type
Review Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Netto, AB, Taly, AB, Kulkarni, GB, Uma Maheshwara Rao, GS, Rao, S. Prognosis of patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurol India. 2011;59:707711. DOI: 10.4103/0028-3886.86545.Google ScholarPubMed
Deitelzweig, SB, McCormick, L. Hyponatremia in hospitalized patients: the potential role of tolvaptan. Hosp Pract. 2011;39:8798. DOI: 10.3810/hp.2011.08.584.CrossRefGoogle Scholar
Cui, H, He, G, Yang, S, et al. Inappropriate antidiuretic hormone secretion and cerebral salt-wasting syndromes in neurological patients. Front Neurosci. 2019;13:1170. DOI: 10.3389/fnins.2019.01170.CrossRefGoogle ScholarPubMed
Anandan, C, Khuder, SA, Koffman, BM. Prevalence of autonomic dysfunction in hospitalized patients with Guillain-Barré syndrome. Muscle Nerve. 2017;56:331333. DOI: 10.1002/mus.25551.CrossRefGoogle ScholarPubMed
Chakraborty, T, Kramer, CL, Wijdicks, EFM, Rabinstein, AA. Dysautonomia in Guillain-Barré syndrome: prevalence, clinical spectrum, and outcomes. Neurocrit Care. 2020;32:113120. DOI: 10.1007/s12028-019-00781-w.CrossRefGoogle ScholarPubMed
Rumalla, K, Reddy, AY, Letchuman, V, Mittal, MK. Hyponatremia in Guillain-Barré syndrome. J Clin Neuromuscul Dis. 2017;18:207217. DOI: 10.1097/CND.0000000000000157.CrossRefGoogle ScholarPubMed
Davies, AG. Inappropriate secretion of antidiuretic hormone in Guillain-Barré syndrome. Postgrad Med J. 1971;47:651653.CrossRefGoogle ScholarPubMed
Posner, JB, Ertel, NH, Kossmann, RJ, Scheinberg, LC. Hyponatremia in acute polyneuropathy. Four cases with the syndrome of inappropriate secretion of antidiuretic hormone. Arch Neurol. 1967;17:530. DOI: 10.1001/archneur.1967.00470290084011.CrossRefGoogle ScholarPubMed
Cooper, WC, Green, IJ, Wang, SP. Cerebral salt-wasting associated with the Guillain-Barr’e syndrome. Arch Intern Med. 1965;116:113. DOI: 10.1001/archinte.1965.03870010115014.CrossRefGoogle ScholarPubMed
Sipilä, JO, Kauko, T, Soilu-Hänninen, M. Admission sodium level and prognosis in adult Guillain-Barré syndrome. Int J Neurosci. 2017;127:344349. DOI: 10.3109/00207454.2016.1163551.CrossRefGoogle ScholarPubMed
Wang, Y, Liu, J. Hyponatremia is a predictor for poor outcome in Guillain-Barré syndrome. Neurol Res. 2015;37:347–51. DOI: 10.1179/1743132814Y.0000000455.CrossRefGoogle ScholarPubMed
Saifudheen, K, Jose, J, Gafoor, VA, Musthafa, M. Guillain-Barré syndrome and SIADH. Neurology, 2011;76:701704. DOI: 10.1212/WNL.0b013e31820d8b40.CrossRefGoogle ScholarPubMed
Hiew, FL, Winer, JB, Rajabally, YA. Hyponatraemia in Guillain-Barré syndrome revisited. Acta Neurol Scand. 2016;133:295301. DOI: 10.1111/ane.12459.CrossRefGoogle ScholarPubMed
Colls, BM. Guillain-Barré syndrome and hyponatraemia. Intern Med J. 2003;33:59. DOI: 10.1046/j.1445-5994.2002.00322.x.CrossRefGoogle ScholarPubMed
Gagliardi, D, Faravelli, I, Podestà, MA, et al. Sodium levels predict disability at discharge in Guillain-Barré syndrome: a retrospective cohort study. Front Neurol. 2021;12:729252. DOI: 10.3389/fneur.2021.729252.CrossRefGoogle ScholarPubMed
Lawn, N, Wijdicks, EFM, Burritt, MF. Intravenous immune globulin and pseudohyponatremia. N Engl J Med. 1998;339:632. DOI: 10.1056/NEJM199808273390914.CrossRefGoogle ScholarPubMed
Hoffmann, O, Reuter, U, Schielke, E, Weber, JR. SIADH as the first symptom of guillain-barré syndrome. Neurology. 1999;53:1365. DOI: 10.1212/wnl.53.6.1365-a.CrossRefGoogle ScholarPubMed
Kloesel, B, Hickson, LJ. Severe hyponatremia as the initial sign preceding guillain-barré syndrome, an acute inflammatory demyelinating polyneuropathy: a case report. Case Rep Neurol Med. 2013;2013: 13.Google ScholarPubMed
Çakırgöz, MY, Duran, E, Topuz, C, et al. Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy. Braz J Anesthesiol. 2014;64:195–8. DOI: 10.1016/j.bjane.2013.03.009.CrossRefGoogle ScholarPubMed
James, J, Jose, J. Syndrome of inappropriate secretion of antidiuretic hormone preceding guillain-barré syndrome. J Clin Diagn Res. 2017;11(9):OD16–OD17. DOI: 10.7860/JCDR/2017/30445.10662.Google ScholarPubMed
Zemke, AM, Boles, LH, Gillespie, M, Viljoen, JM. Guillain-Barré syndrome hyponatremia: is it SIADH or pseudohyponatremia? Oxf Med Case Reports. 2018;2018(7):omy042. DOI: 10.1093/omcr/omy042.CrossRefGoogle ScholarPubMed
Inoue, M, Kojima, Y, Shirakashi, Y, Kanda, M, Shibasaki, H. A case of Guillain-Barré syndrome accompanied by syndrome of inappropriate secretion of antidiuretic hormone. Rinsho Shinkeigaku, Japanese. 2010;50:710713. DOI: 10.5692/clinicalneurol.50.710.CrossRefGoogle ScholarPubMed
Ramanathan, S, McMeniman, J, Cabela, R, Holmes-Walker, DJ, Fung, VS. SIADH and dysautonomia as the initial presentation of guillain-barré syndrome. J Neurol Neurosurg Psychiatry. 2012;83:344345. DOI: 10.1136/jnnp.2010.233767.CrossRefGoogle ScholarPubMed
Monzón Vázquez, T, Florit, E, Marqués Vidas, M, Rodríguez Cubillo, B, Delgado Conde, P, Barrientos Guzmán, A. Syndrome of inappropriate antidiuretic hormone hypersecretion associated with guillain-barré syndrome. Nefrologia. 2011;31:498–9. DOI: 10.3265/Nefrologia.pre2011.10897.Google ScholarPubMed
Mount, DM. Fluid and electrolyte disturbances. In: Jameson, J, Fauci, AS, Kasper, DL, Hauser, SL, Longo, DL, Loscalzo, J, ed. Harrison’s principles of internal medicine. McGraw Hill; 2022, 21e.Google Scholar
Yasir, M, Mechanic, OJ. Syndrome of Inappropriate Antidiuretic Hormone Secretion. Treasure Island (FL): StatPearls Publishing; 2022.Google Scholar
Rabinstein, AA, Wijdicks, EF. Hyponatremia in critically ill neurological patients. Neurologist. 2003;9:290300. DOI: 10.1097/01.nrl.0000095258.07720.89.CrossRefGoogle ScholarPubMed
Pfeiffer, G. Dysautonomia in Guillain-Barré syndrome. Der Nervenarzt. 1999; 70: 136148. 10.1007/s001150050414.CrossRefGoogle ScholarPubMed
Haymaker, WE, Kernohan, JW. The landry-Guillain-Barré syndrome; a clinicopathologic report of 50 fatal cases and a critique of the literature. Medicine (Baltimore). 1949;28:59141.CrossRefGoogle Scholar
Griffin, D, Asad, H, Patel, P, Gohar, A. Flaccid paralysis with hyponatremia: think Guillain-Barre syndrome. Cureus. 2020;12: e7113. DOI: 10.7759/cureus.7113.Google ScholarPubMed
Bartter, FC, Schwartz, WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med. 1967;42:790806. DOI: 10.1016/0002-9343(67)90096-4.CrossRefGoogle ScholarPubMed
Hodson, AK, Hurwitz, BJ, Albrecht, R. Dysautonomia in Guillain-Barré syndrome with dorsal root ganglioneuropathy, wallerian degeneration, and fatal myocarditis. Ann Neurol. 1984;15:8895. DOI: 10.1002/ana.410150116.CrossRefGoogle ScholarPubMed
Pithadia, AB, Kakadia, N. Guillain-Barré syndrome (GBS). Pharmacol Rep. 2010;62:220232. DOI: 10.1016/s1734-1140(10)70261-9.CrossRefGoogle ScholarPubMed
Fujiwara, S, Manabe, Y, Nakano, Y, Omote, Y, Narai, H, Abe, K. A case of Miller-fisher syndrome with syndrome of inappropriate secretion of antidiuretic hormone. Case Rep Neurol. 2021;13: 380383.CrossRefGoogle ScholarPubMed
Yuki, N, Yamada, M, Tagawa, Y, Takahashi, H, Handa, S. Pathogenesis of the neurotoxicity caused by anti-GD2 antibody therapy. J Neurol Sci. 1997;149:127130. DOI: 10.1016/s0022-510x(97)05390-2.CrossRefGoogle ScholarPubMed
Sheikh, MM, Ahmad, E, Jeelani, HM, Riaz, A, Muneeb, A. COVID-19 pneumonia: an emerging cause of syndrome of inappropriate antidiuretic hormone. Cureus. 2020;12:e8841. DOI: 10.7759/cureus.8841.Google ScholarPubMed
Cortassa, GM, Bottone, S, Nebiolo, M. A case of guillain-barré syndrome post COVID-19. It J Emerg Med. 2020;9:78–79. DOI: 10.23736/S2532-1285.20.00024-5.Google Scholar
Santoro, C, Guerra, T, D’Errico, E, et al. Guillain-Barré syndrome associated with inappropriate secretion of antidiuretic hormone following SARS-coV-2 infection: a case-report. Clin Case Rep. 2021;9(10):e04667. DOI: 10.1002/ccr3.4667.CrossRefGoogle ScholarPubMed
Cooke, CR, Latif, KA, Huch, KM, Wall, BM. Inappropriate antidiuresis and hyponatremia with suppressible vasopressin in Guillain-Barré syndrome. Am J Nephrol. 1998;18:7176. DOI: 10.1159/000013309.CrossRefGoogle ScholarPubMed
Penney, MD, Murphy, D, Walters, G. Resetting of osmoreceptor response as cause of hyponatraemia in acute idiopathic polyneuritis. Br Med J. 1979;2:14741476.CrossRefGoogle ScholarPubMed
Wijdicks, EFM, Ropper, AH, Nathanson, JA. Atrial natriuretic factor and blood pressure fluctuations in guillain-barré syndrome. Ann Neurol. 1990;27:337338. DOI: 10.1002/ana.410270320.CrossRefGoogle ScholarPubMed
Lenhard, T, Grimm, C, Ringleb, PA. Renal salt wasting as part of dysautonomia in Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2011;82:10511053. 10.1136/jnnp.2009.192369.CrossRefGoogle ScholarPubMed
Tota, B, Angelone, T, Cerra, MC. The surging role of chromogranin a in cardiovascular homeostasis. Front Chem. 2014;14(2):64. DOI: 10.3389/fchem.2014.00064.Google Scholar
Hochman, MS, Kobetz, SA, Handwerker, JV. Inappropriate secretion of antidiuretic hormone associated with Guillain-Barré syndrome. Ann Neurol. 1982;11:322323. DOI: 10.1002/ana.410110317.CrossRefGoogle ScholarPubMed
Ramaprasad, ST, Poretsky, L. Life-threatening hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a patient with the miller fisher syndrome. Endocr Pract. 1995;1:163165. DOI: 10.4158/EP.1.3.163.CrossRefGoogle Scholar
Wankar, A, Pauranik, N, Dinesh, C. Severe hyponatremia as the initial sign preceding guillain-barré syndrome: a case report. Egy J Int Med. 2014;26:179183.CrossRefGoogle Scholar
Sahay, M, Sahay, R. Hyponatremia: a practical approach. Indian J Endocrinol Metab. 2014;18:760771. 10.4103/2230-8210.141320.CrossRefGoogle ScholarPubMed
Nguyen, MK, Rastogi, A, Kurtz, I. True hyponatremia secondary to intravenous immunoglobulin. Clin Exp Nephrol. 2006;10:124126. DOI: 10.1007/s10157-006-0416-9.CrossRefGoogle ScholarPubMed
Kim, GH. Pseudohyponatremia: does it matter in current clinical practice? Electrolyte blood press. 2006.CrossRefGoogle Scholar
Kamoi, K, Ebe, T, Kobayashi, O, et al. Atrial natriuretic peptide in patients with the syndrome of inappropriate antidiuretic hormone secretion and with diabetes insipidus. J Clin Endocrinol Metab. 1990;70:13851390. DOI: 10.1210/jcem-70-5-1385.CrossRefGoogle ScholarPubMed
Maffi, G, Lombardi, R, Spreafico, SM, Bignamini, D, Fracanzani, AL. Autonomic dysfunction and SIADH as first signs of guillain-barre syndrome. Austin J Clin Case Rep. 2021;8:1199.Google Scholar
Kaneko, K, Shioya, T, Yabuta, K. Inappropriate secretion of antidiuretic hormone and transient hypertension associated with guillain-barré syndrome. Pediatr Neurosci. 1989;15:257259. DOI: 10.1159/000120477.CrossRefGoogle ScholarPubMed
Srisung, W, Prongdong, A, Laengvejkal, P, Phisitkul, S. Acute motor and sensory axonal neuropathy associated syndrome of inappropriate antidiuretic hormone secretion. Southwest Resp Crit Car Chron. 2015;3:1820.Google Scholar
Asti, D, Fuca, N, Wong, J, Mudduluru, BM, El-Charabaty, E. Syndrome of inappropriate antidiuretic hormone as the initial presentation in guillain-barré syndrome. J Nephropathol. 2018;7:207209. DOI: 10.15171/jnp.2018.42.CrossRefGoogle Scholar
Shah, PM, Dhakre, VW, Veerasuri, R, Bhabhor, A. Dysautonomia and hyponatraemia as harbingers of Guillain-Barre syndrome. BMJ Case Rep. 2019;12:e226925.CrossRefGoogle ScholarPubMed
Ternero Vega, JE, León, RG, Delgado, DA, Baturone, MO. Guillain-Barré syndrome and hyponatraemia, english, spanish. Neurologia. 2020;35:282284. 10.1016/j.nrl.2017.12.010.Epub.CrossRefGoogle Scholar
Lindner, G, Schwarz, C, Haidinger, M, Ravioli, S. Hyponatremia in the emergency department. Am J Emerg Med. 2022;60, 18. DOI: 10.1016/j.ajem.2022.07.023.CrossRefGoogle ScholarPubMed
Lawless, SJ, Thompson, C, Garrahy, A. The management of acute and chronic hyponatraemia. Ther Adv Endocrinol Metab 2022;13.CrossRefGoogle ScholarPubMed
Kim, DK, Joo, KW. Hyponatremia in patients with neurologic disorders. Electrolyte Blood Press. 2009;7:51.CrossRefGoogle ScholarPubMed
Misra, UK, Kalita, J, Bhoi, SK, Singh, RK. A study of hyponatremia in tuberculous meningitis. J Neurol Sci. 2016;367:152157. DOI: 10.1016/j.jns.2016.06.004.CrossRefGoogle ScholarPubMed
Meena, A K, Khadilkar, S V, Murthy, J M K. Treatment guidelines for Guillain-Barré syndrome. Ann Indian Acad Neurol. 2011;14:S73S81. DOI: 10.4103/0972-2327.83087.CrossRefGoogle ScholarPubMed