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Guillain-Barré syndrome with respiratory risk — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsGuillain-Barré syndrome with respiratory riskSCE Acute Medicine

A 51-year-old man presents with progressive ascending weakness 12 days after diarrhoeal illness. Reflexes are absent and he has bilateral facial weakness. Forced vital capacity is 16 mL/kg and oxygen saturation is 97% on air. What is the most appropriate next step in management?

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Correct answer: B — Admit for urgent neurology review and respiratory monitoring

GBS can cause respiratory failure despite normal oxygen saturation until late; low FVC needs urgent monitoring and possible critical care involvement. Steroids are not beneficial as definitive therapy; IVIg or plasma exchange may be needed. Outpatient investigation is unsafe. The pearl is that ventilatory mechanics, not oxygen saturation, predict impending failure in neuromuscular weakness.

Reference: Association of British Neurologists GBS guidance; NICE CKS