[DrSeddik]

a 32 year old female comes to the ER with bilateral weakness of the lower limbs that has been going on for 2 days now, recently accompanied with severe numbness, tingling and burning in the same area. Her BP is 160/100, heart rate is 78 bpm. You examined her to find complete flaccid paraplesia of the lower limbs, knee and ankle reflexes are lost. When asked she confers a history of diarrheal disease about 3 weeks ago. While she waits for a spinal tap she starts complaining of dyspnea and drowsiness, you were instantly alarmed and you suggest that she should be intubated. The intern disagrees with you and says she shouldn't be subjected to the aggressive procedure. You try to prove your point by taking an Arterial Blood Gases sample to the lab. What do you expect to see:

a- a normal A-a gradient
b- low CO2 and respiratory alkalosis
c- low PaO2, high PaCO2, low pH, and elevated HCO3
d- low PaO2, other values are normal

 

[khanar]

This seems to be GBS
I'd choose option d

 

[khanar]

I choose e

 

[HouseWannabe]

I think she has Acute idiopathic demyelinating polyneuropathy (AIDP), GBS so D.

Acute Resp acidosis because of the diaphragm paralysis= low pO2, High pCO2, low pH, but I am not sure about HCO3, I thought that would be elevated if it was Chronic resp acidosis....

 

[DrSeddik]

I think she has Acute idiopathic demyelinating polyneuropathy (AIDP), GBS so D.

Acute Resp acidosis because of the diaphragm paralysis= low pO2, High pCO2, low pH, but I am not sure about HCO3, I thought that would be elevated if it was Chronic resp acidosis....

every thing you said is correct, but take another look at the options

I'm starting it in Step 1 forum so that more people can see it.

 

[drtthakur]

drtthakur

this is classic of gbs type2 respi failure is a complication of gbs leading 2 type 2 failure high co2 low o2 as the respiratory muscles are also invoved there is increased co2 retention

 

[[email protected]]

ANSWER IS C...GBS will have respiratory acidosis with compensatory response...so it should be c...

 

[dryogi]

c- low PaO2, high PaCO2, low pH, and elevated HCO3

 

[doctorsmonsters]

a- a normal A-a gradient

there's hypoventilation due to resp muscle paralysis, normal A-a gradient.