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GBS – Autonomic Instability Management — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularGBS – Autonomic Instability ManagementSCE Neurology

A 60-year-old man with GBS is showing signs of autonomic instability — alternating tachycardia and bradycardia, labile blood pressure, and excessive sweating. What is the most important management principle for autonomic dysfunction in GBS?

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Correct answer: A — Avoid drugs that affect heart rate, monitor on a cardiac-monitored bed, and treat haemodynamic instability cautiously

Autonomic instability in GBS is common and potentially life-threatening. Management principles include: continuous cardiac monitoring, cautious use of vasoactive drugs (autonomic swings mean blood pressure and heart rate can change rapidly and unpredictably), avoiding drugs that further alter heart rate (beta-blockers can cause profound bradycardia), treating sustained symptomatic bradycardia with atropine cautiously, and managing hypertension with short-acting agents. A: Beta-blockers risk profound bradycardia due to autonomic instability. C: Pacing is rarely needed unless sustained symptomatic bradycardia. D: Atropine should be used cautiously, not for all bradycardia. E: Adrenaline risks severe hypertensive rebound.

Reference: EAN/PNS GBS Guidelines (2023); ABN GBS Guidelines