Metabolic Neuropathy Follow-up

Author: Tarakad S Ramachandran, MBBS, FRCP(C), FACP; Chief Editor: Nicholas Lorenzo, MD more...

Updated: Feb 6, 2012

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Further Inpatient Care
Further Outpatient Care
Inpatient & Outpatient Medications
Transfer
Complications
Prognosis
Patient Education
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Tables

References

Further Inpatient Care

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.

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.

Inpatient & Outpatient Medications

Patients should keep a calendar with all medications and their adverse effects.

Transfer

Transfer patients to an inpatient facility whenever complications develop.

Patients with metabolic neuropathy can develop autonomic dysfunction and are at high risk to develop asymptomatic myocardial infarction and sudden death.^[23]
Patients with diabetes who have neuropathy can develop foot ulcers.

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.

Patient Education

Provide patients with education about the disease and methods of preventing complications.

Contributor Information and Disclosures

Author

Tarakad S Ramachandran, MBBS, FRCP(C), FACP Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Specialty Editor Board

Milind J Kothari, DO Professor and Vice-Chair, Department of Neurology, Pennsylvania State University College of Medicine; Consulting Staff, Department of Neurology, Penn State Milton S Hershey Medical Center

Milind J Kothari, DO is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa

Disclosure: Baxter Grant/research funds Other; Amgen Grant/research funds None

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Nicholas Lorenzo, MD Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Fernando Dangond, MD, and Luis Carlos Sanin, MD, to the development and writing of this article.

References

Tamborlane WV, Ahern J. Implications and results of the Diabetes Control and Complications Trial. Pediatr Clin North Am. Apr 1997;44(2):285-300. [Medline].
Pop-Busui R, Herman WH, Feldman EL, Low PA, Martin CL, Cleary PA, et al. DCCT and EDIC studies in type 1 diabetes: lessons for diabetic neuropathy regarding metabolic memory and natural history. Curr Diab Rep. Aug 2010;10(4):276-82. [Medline].
Greene DA, Stevens MJ, Feldman EL. Diabetic neuropathy: scope of the syndrome. Am J Med. Aug 30 1999;107(2B):2S-8S. [Medline].
Voulgari C, Psallas M, Kokkinos A, Argiana V, Katsilambros N, Tentolouris N. The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetes. J Diabetes Complications. May-Jun 2011;25(3):159-67. [Medline].
Dyck PJ, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology. Dec 10 1999;53(9):2113-21. [Medline].
Harati Y. Frequently asked questions about diabetic peripheral neuropathies. Neurol Clin. Aug 1992;10(3):783-807. [Medline].
Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (3rd and last part) (author's transl)]. Diabete Metab. Dec 1977;3(4):245-56. [Medline].
Arezzo JC. New developments in the diagnosis of diabetic neuropathy. Am J Med. Aug 30 1999;107(2B):9S-16S. [Medline].
Chalk CH. Acquired peripheral neuropathy. Neurol Clin. Aug 1997;15(3):501-28. [Medline].
Dick PJ, Thomas PK, eds. Peripheral Neuropathy. 3^rd ed. Philadelphia: WB Saunders Co; 1993.
Comi G, Corbo M. Metabolic neuropathies. Curr Opin Neurol. Oct 1998;11(5):523-9. [Medline].
Thomas PK, Tomlinson DR. Diabetic and hypoglycemic neuropathy. In: Dick PJ, Thomas PK, eds. Peripheral Neuropathy. Philadelphia: WB Saunders Co; 1993:1221.
Apfel SC. Neurotrophic factors in the therapy of diabetic neuropathy. Am J Med. Aug 30 1999;107(2B):34S-42S. [Medline].
Misiunas A, Niepomniszcze H, Ravera B, et al. Peripheral neuropathy in subclinical hypothyroidism. Thyroid. Aug 1995;5(4):283-6. [Medline].
Kyle RA. Monoclonal proteins in neuropathy. Neurol Clin. Aug 1992;10(3):713-34. [Medline].
Barlogie B, Tricot G, Anaissie E, Shaughnessy J, Rasmussen E, van Rhee F, et al. Thalidomide and hematopoietic-cell transplantation for multiple myeloma. N Engl J Med. Mar 9 2006;354(10):1021-30. [Medline].
Simmons DN, Lisle DA, Linklater JM. Imaging of Peripheral Nerve Lesions in the Lower Limb. Techniques in Foot & Ankle Surgery. 2008/12;7(4):224-237.
Lisle DA, Johnstone SA. Usefulness of muscle denervation as an MRI sign of peripheral nerve pathology. Australas Radiol. Dec 2007;51(6):516-26. [Medline].
Krishnan AV, Lin CS, Park SB, Kiernan MC. Assessment of nerve excitability in toxic and metabolic neuropathies. J Peripher Nerv Syst. Mar 2008;13(1):7-26. [Medline].
Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain. Dec 1999;83(3):389-400. [Medline].
Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care. Jul 2008;31(7):1448-54. [Medline].
Azoulay D, Samuel D, Castaing D, et al. Domino liver transplants for metabolic disorders: experience with familial amyloidotic polyneuropathy. J Am Coll Surg. Dec 1999;189(6):584-93. [Medline].
Kaminski HJ, Ruff RL. Neurologic complications of endocrine diseases. Neurol Clin. Aug 1989;7(3):489-508. [Medline].
Burn DJ, Bates D. Neurology and the kidney. J Neurol Neurosurg Psychiatry. Dec 1998;65(6):810-21. [Medline].
Lagueny A. [Metabolic and nutritional neuropathies]. Rev Prat. Apr 1 2000;50(7):731-5. [Medline].
Parry GJ. Management of diabetic neuropathy. Am J Med. Aug 30 1999;107(2B):27S-33S. [Medline].

Table 1. Symptoms and Signs of Peripheral Neuropathy*

Table 1. Symptoms and Signs of Peripheral Neuropathy*

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.^[13]

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