Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy

Sodium Levels Predict Disability at Discharge in Guillain-Barré Syndrome: A Retrospective Cohort Study

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculopathy with potentially severe complications. Clinical tools for risk stratification have been developed, but no definitive prognostic biomarker has been reported. Hyponatremia is frequent in GBS patients, but the impact of serum sodium levels on clinical outcomes is still ill-defined. In this retrospective cohort study, we included all adult patients diagnosed with GBS spectrum disorders at our center from January 2010 to July 2020. Disability at discharge was assessed with the GBS Disability Score (GDS), and all clinical and laboratory data was retrieved from medical charts. Thirty (58.8%) of the 51 subjects included in the study were discharged with severe residual disability (GDS ≥ 3). After accounting for relevant confounders, the odds of experiencing severe disability decreased by 27% (p = 0.027) for each unitary increase in serum sodium concentration. Thirteen (25.5%) patients were diagnosed with mild to moderate hyponatremia; the use of intravenous immune globulin (IVIG) independently increased the odds of developing hyponatremia. In conclusion, we found a significant, independent association between baseline serum sodium levels and severe disability at discharge in GBS patients. In our cohort, hyponatremia was more frequently observed after treatment with IVIG, suggesting dilutional pseudohyponatremia as a probable cause.

Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

The differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) in patients with neurological disorders has been a perplexing clinical controversy. The purpose of this review is to summarize the characteristics and risk factors of patients with different types of neurological disorders complicated by hyponatremia (HN) and review various methods to distinguish SIADH from CSWS. Common neurological disorders with high rates of HN include subarachnoid hemorrhage (SAH), traumatic brain injuries, stroke, cerebral tumors, central nervous system (CNS) infections, and Guillain-Barré syndrome (GBS), which have their own characteristics. Extracellular volume (ECV) status of patients is a key point to differentiate SIADH and CSWS, and a comprehensive assessment of relevant ECV indicators may be useful in differentiating these two syndromes. Besides, instead of monitoring the urinary sodium excretion, more attention should be paid to the total mass balance, including Na⁺, K⁺, Cl^-, and extracellular fluid. Furthermore, the dynamic detection of fractional excretions (FE) of urate before and after correction of HN and a short-term infusion of isotonic saline solution may be useful in identifying the etiology of HN. As for brain natriuretic peptide (BNP) or N-terminal prohormone of BNP (NT-proBNP), more prospective studies and strong evidence are needed to determine whether there is a pertinent and clear difference between SIADH and CSWS.

Impact of fast track surgery on inflammatory factors, gastrointestinal hormones, and gastrointestinal function in patients undergoing hepatobiliary surgery

BACKGROUND

Hepatobiliary surgery, due to complex physiological and anatomical structures, is difficult and risky, and patients often have a strong stress reaction, which will affect the smooth operation and postoperative rehabilitation. Fast track surgery can strengthen perioperative process management by using various effective measures confirmed by evidence-based medicine, and its application in hepatobiliary surgery is worthy of affirmation. However, there are few studies reporting inflammatory factors and gastrointestinal hormones in patients undergoing hepatobiliary surgery using a fast track surgery program.

AIM

To study the effect of fast track surgery on inflammatory factors, gastrointestinal hormones, and gastrointestinal function in patients undergoing hepatobiliary surgery.

METHODS

A total of 126 patients undergoing hepatobiliary surgery from May 2017 to April 2018 were divided into an intervention group and a control group. The control group was given conventional surgical management, and the intervention group given was given fast track surgery management. Serum inflammatory factors, gastrointestinal hormones, gastrointestinal function recovery time, and complications were compared between the two groups.

RESULTS

Serum tumor necrosis factor-α, C reactive protein, and interleukin-6 were significantly lower in the intervention group than in the control group (36.20 pg/mL ± 5.32 pg/mL vs 43.55 pg/mL ± 6.12 pg/mL, 12.42 mg/L ± 2.35 mg/L vs 18.65 mg/L ± 3.24 mg/L, 10.24 pg/L ± 2.10 pg/L vs 15.04 pg/L ± 2.32 pg/L; t = 7.194, 12.355, 12.175; P < 0.05 or P < 0.01). Serum motilin and gastrin were significantly higher in the intervention group than in the control group (205.45 pg/mL ± 25.16 pg/mL vs 168.24 pg/mL ± 24.25 pg/mL, 124.32 pg/mL ± 24.15 pg/mL vs 104.36 pg/mL ± 20.42 pg/mL; t = 8.452, 5.009; P < 0.05, P < 0.01). Time to recovery of bowel sounds, time to anal exhaust, time to first defecation, and postoperative hospital stay were significantly shorter in the intervention group than in the control group [16.45 h ± 3.12 h vs 21.24 h ± 3.65 h, 20.34 h ± 4.54 h vs 41.25 h ± 6.12 h, 38.65 h ± 5.24 h vs 57.42 h ± 7.15 h, 9.21 d ± 1.32 d vs 13.54 d ± 2.12 d; t = 7.918, 21.780, 18.607, 13.762; P < 0.05 or P < 0.01). The rate of complications such as incision infection was significantly lower in the intervention group than in the control group (9.52% vs 26.98%, χ² = 6.436, P < 0.05).

CONCLUSION

Fast track surgery can promote gastrointestinal function recovery and reduce complications in patients undergoing hepatobiliary surgery, which may be related to inhibiting inflammatory response and regulating gastrointestinal hormones.