Age: 56.0
Sex: F
Vaccine: FLUX, FLUX
Symptoms: Blood aldosterone, Blood potassium decreased, Blood sodium decreased, Blood uric acid decreased, Brain natriuretic peptide increased
Clinical narrative: This case was reported in a literature article and described the occurrence of Guillain Barre Syndrome followed by a renal salt-wasting syndrome in a 56-year-old female subject who was vaccinated with Influenza vaccine unspecified (manufacturer unspecified). The subject's weight was 85 kg at the time of the event. No further information regarding the subject's medical, family history or concurrent medication has been provided. On an unspecified date, the subject received an unspecified dose of Influenza vaccine unspecified (unknown route and injection site). A few days after vaccination with Influenza vaccine unspecified, the subject experienced vomiting, progressive weakness and tingling, that had started in the lower extremities and then extended to the upper extremities. 2 weeks after, the subject visited specialists. No information has been provided regarding any clinical examinations or investigations performed on the subject on admission to hospital, but the author's report that neurological and cerebral spinal fluid evaluations suggested Guillain Barre Syndrome. The subject was hospitalised. The subject's condition deteriorated quickly within two days of her admission to the point that she required mechanical ventilation. By the third day in hospital her serum sodium level had decreased from 137 mEq/L to 122 mEq/L over 26 hours while her serum potassium ranged from 3.2 to 3.7 mEq/L and her uric acid was 1.5 mg/dL. No information has been facilitated regarding the subject's initial treatment but it has been reported that intravenous immunoglobulin was not commenced initially. Her recent oral intake had been poor and her recorded admission net fluid gain was only 73 mL, so she was presumed to be hypo- to euvolaemic. Over the 26 hours she had an intake of 1.2 L of 5% dextrose 1/2 normal saline with an output of 2.2 L of urine. Therefore her net fluid balance was -1.0 L. The concentration of urine sodium was 235 mEq/L and urine potassium 41 mEq/L, so her net (Na+; K+) was -526 mEq during this period. Her brain natriuretic peptide level was 964 pg/mL, plasma renin activity 2.2 ng/mL/h and serum aldosterone was 12 ng/dL. The subject was diagnosed with Guillain Barre Syndrome associated renal salt-wasting. Treatment was initiated with 3% saline at 80-100 mL/hour with poor response until fludrocortisone 0.1 mg daily was added after 3 days. Her urine sodium level dropped to less than 10 mEq/L, so plasmapheresis was initiated with neurological and sodium level improvement (6-8 mEq/day). At the time of reporting, the events were improved. Author's conclusion: "Although Guillain Barre Syndrome associated syndrome of inappropriate antidiuretic hormone secretion is well-described, to our knowledge, Guillain Barre Syndrome associated renal salt-wasting has only been reported once in the literature. Renal salt-wasting has been hypothesized to be due to Guillain Barre Syndrome-autonomic dysfunction, resultant sympathoadrenal   [Due to memory limitations, the remainder of this text could not be compared.]  enal dysregulation and inappropriate Brain Natriuretic Peptide secretion. It is vital to recognize this rare Guillain-Barre associated renal salt-wasting complication and differentiate the entity from Syndrome of Inappropriate Antidiuretic Hormone (ADH) secretion (SIADH) due to differences in treatment plans."