Diagnostics
- Consider obtaining LP and/or EMG (will be falsely normal in the acute setting)
- MRI may show thickening of the cauda equina roots
- Obtain NIFs/VCs atleast twice daily
- Upgrade to ICU if respiratory compromise (tachypnea & increased work of breathing)
IVIG
- Check IgA to avoid anaphylaxis
- Baseline CBC, BMP, LFTs, Mg, Phos
- Pre-Tx (30 min prior): acetaminophen 650mg, diphenhydramine 25mg, 500 cc isolyte
- 0.4g/kg/day x5 days; give with 500cc NS bolus before and after
- Post-Tx (30 min after): 500 cc isolyte
- Risks: aseptic meningitis, rash, renal failure, hyperviscosity syndrome, stroke, volume overload
PLEX
- Baseline and daily CBC, BMP, LFT’s, Ca, PT/PTT, Fibrinogen
- Shiley to be placed by vascular access
- Sessions to be performed every other day
- Treatment with plasma exchange or IVIG hastens recovery from GBS
- The beneficial effects of PLEX and IVIG are equivalent