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Guillain-Barre syndrome with respiratory compromise — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsGuillain-Barre syndrome with respiratory compromiseSCE Acute Medicine

A 39-year-old man develops ascending leg weakness two weeks after diarrhoea. Examination shows areflexia, bifacial weakness and reduced cough. FVC falls from 2.3 L to 1.2 L over six hours and oxygen saturation remains 98% on air. What is the most appropriate next step in management?

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Correct answer: A — Admit to critical care and start disease-modifying therapy for Guillain-Barre syndrome

Rapidly falling vital capacity in Guillain-Barre syndrome predicts respiratory failure despite preserved oxygen saturation. Critical care monitoring and IV immunoglobulin or plasma exchange should be considered. Corticosteroids are not effective definitive therapy for GBS. The key lesson is that neuromuscular respiratory failure is detected by ventilation and cough, not by pulse oximetry early on.

Reference: NICE CKS Guillain-Barre syndrome, ABN peripheral neuropathy guidance