Metabolic Neuropathy Follow-up
- Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE more...
Further Outpatient Care
Provide close outpatient follow-up care to patients with metabolic neuropathy to treat the primary metabolic condition and to assess treatment results and adverse effects.
Further Inpatient Care
See the list below:
- Inpatient care of complications of the metabolic disorder (hyperosmolar state, silent myocardial infarction, arrhythmias) is required.
- Local treatment of ulcerated diabetic foot and surgical procedures to alleviate pain or impending infection are best performed in the hospital setting.
Inpatient & Outpatient Medications
Patients should keep a calendar with all medications and their adverse effects.
Transfer patients to an inpatient facility whenever complications develop.
See the list below:
- Patients with metabolic neuropathy can develop autonomic dysfunction and are at high risk to develop asymptomatic myocardial infarction and sudden death.
- Patients with diabetes who have neuropathy can develop foot ulcers.
See the list below:
- Prognosis depends on the control of the primary metabolic condition. If the metabolic condition is controlled, usually the neuropathy also is reasonably well controlled.
- Autonomic involvement has a worse prognosis than other neuropathies because of the risk of asymptomatic myocardial infarction.
Provide patients with education about the disease and methods of preventing complications.
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|Small-Fiber Sensory||Large-Fiber Sensory||Autonomic|
|Burning pain||Loss of vibration||Heart rate changes|
|Cutaneous allodynia||Proprioception loss||Postural blood pressure change|
|Paresthesias||Loss of reflexes||Abnormal sweating|
|Lancinating pain||Slowed NCVs||Gastroparesis|
|Loss pain/temperature||Sensory ataxia||Impotence|
|Foot ulcers||Weakness||Abnormal ejaculation|
|Visceral pain loss|
|* Modified from Apfel, 1999.|