Diabetic Ketoacidosis Associated with Guillain-Barre Syndrome with Autonomic Dysfunction.

Abstract

A37-year-old womanwas admitted in a comatose state, after exhibiting fever and diarrhea. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (672 mg/dl), metabolic addosis, and positive urinary ketone bodies. On the fifth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from dysphagia, hypesthesia and motor weakness, followed by respiratory failure. Cerebrospinal fluid analysis was suggestive of Guillain-Barre syndrome (GBS). Autonomic dysfunction was manifested as tachycardia and mild hypertension in the acute stage. Marked orthostatic hypotension persisted long after paresis was improved, indicating an atypical clinical course of GBS. (Internal Medicine 39: 495-498, 2000)

Human immunodeficiency virus infection presenting as a fatal case of Guillain-Barré syndrome on a background of diabetes mellitus

“…[4][5][6] The observed very high fever in the last two days of admission in the patient may suggest an autonomic component in the presentation of GBS as demonstrated by González-Suárez et al [6] Though GBS has been associated with HIV but not commonly with diabetes mellitus. [7][8][9][10][11][12][13][14] It is yet to be reported in a patient with concomitant HIV infection and diabetes mellitus as we observed. HIV is thought to be directly associated with the onset of GBS at sero-conversion or in the chronic phase.…”

“…[7][8][9][10] Also, GBS has been reported as a presentation in association with diabetes mellitus in the setting of diabetic neuropathy, diabetic coma or recent elevation of blood sugar levels. [11][12][13][14] But no report of GBS in Nigeria occurring in the setting of both HIV and diabetes mellitus has been observed.…”

Orthostatic hypotension as a presenting symptom of the Guillain–Barré syndrome

“…Two months later, the ileus and orthostatic hypotension were gradually recovered, but he still had impaired distal pain sensation and abnormal nerve conduction. Dysautonomia is common in GBS and orthostatic hypotension is found in 20-43% of the patients, but it is rarely a presenting and persistent feature [1][2][3]. The patient had been consuming 200 g of alcohol everyday for the past 17 years, and gave up the habit 2 months before attack.…”

“…The patient had been consuming 200 g of alcohol everyday for the past 17 years, and gave up the habit 2 months before attack. Both alcoholism and diabetes mellitus could cause diffuse axonal lesions [1,4]. We speculated that preceding alcoholism, just as diabetes mellitus, might compromise the patient to extensive involvement of the autonomic nerves system, leading to an atypical course and prolonged recovery [1].…”

“…Both alcoholism and diabetes mellitus could cause diffuse axonal lesions [1,4]. We speculated that preceding alcoholism, just as diabetes mellitus, might compromise the patient to extensive involvement of the autonomic nerves system, leading to an atypical course and prolonged recovery [1]. In a previously asymptomatic patient, acute onset of dysautonomia should alert us to the possibility of GBS [2].…”