Review Question - QID 109680

A 27-year-old woman presents to the emergency department with weakness of her legs which has progressed to an inability for her to stand. The patient works as a school teacher in Alaska and regularly goes hiking and camping. She recently returned from a camping trip where she hiked through tall brush and drank from mountain streams. The patient was also involved in a motor vehicle accident 2 days ago but did not seek treatment. The patient had a recent bout of diarrhea but is otherwise generally healthy. Her temperature is 99.5°F (37.5°C), blood pressure is 120/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for an anxious woman with 1/5 strength of the patient’s lower extremities and 2/5 strength of her trunk muscles with abnormal sensations such as tingling and prickling that is symmetrical in her lower extremities. Laboratory studies are ordered as seen below.

Hemoglobin: 15 g/dL
Hematocrit: 43%
Leukocyte count: 6,500/mm^3 with normal differential
Platelet count: 194,000/mm^3

Serum:
Na+: 138 mEq/L
Cl-: 102 mEq/L
K+: 4.4 mEq/L
HCO3-: 24 mEq/L
BUN: 20 mg/dL
Glucose: 120 mg/dL
Creatinine: 1.0 mg/dL
Ca2+: 10.2 mg/dL
pH: 7.44
PaCO2: 10 mmHg
PaO2: 90 mmHg
AST: 12 U/L
ALT: 10 U/L

The patient complains of difficulty breathing. An arterial blood gas is below.

pH: 7.35
PaCO2: 30 mmHg
PaO2: 80 mmHg

The patient is intubated and sent to the ICU. Which of the following is associated with the most likely diagnosis?