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:
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Inpatient care of complications of the metabolic disorder (hyperosmolar state, silent myocardial infarction, arrhythmias) is required.
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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
Transfer patients to an inpatient facility whenever complications develop.
Complications
See the list below:
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Patients with metabolic neuropathy can develop autonomic dysfunction and are at high risk to develop asymptomatic myocardial infarction and sudden death.
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Patients with diabetes who have neuropathy can develop foot ulcers.
Prognosis
See the list below:
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Prognosis depends on the control of the primary metabolic condition. If the metabolic condition is controlled, usually the neuropathy also is reasonably well controlled.
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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.
Tables
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 |
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* Modified from Apfel, 1999. [15] |
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