title: Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit.
  
  
  METHODS
  A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service.
  
  
  CONCLUSIONS
  Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis.
authors.affiliation: Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mensure Yılmaz
authors.initials: MY
authors.lastname: Çakırgöz
authors.affiliation: Şehit Kamil State Hospital, Gaziantep, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Duran
authors.affiliation: Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Topuz
authors.affiliation: Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Kara
authors.affiliation: Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Namigar
authors.initials: N
authors.lastname: Turgut
authors.affiliation: Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ülkü Aygen
authors.initials: ÜA
authors.lastname: Türkmen
authors.affiliation: Department of Anesthesiology and Reanimation, Çorlu Vatan Private Hospital, Tekirdağ, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Turanç
authors.affiliation: Department of General Surgery Çorlu Vatan Private Hospital, Tekirdağ, Turkey.
authors.forename: Mustafa Önder
authors.initials: MÖ
authors.lastname: Dolap
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylül University, Konak, Turkey. Electronic address: vhanci@gmail.com.
authors.forename: Volkan
authors.initials: V
authors.lastname: Hancı
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007010:Hyponatremia / Q000209:etiology / Q000628:therapy; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007177:Inappropriate ADH Syndrome / Q000209:etiology* / Q000628:therapy; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: Guillain–Barré syndrome; Laparoscopic cholecystectomy; Syndrome of inappropriate antidiuretic hormone secretion