Metabolic neuropathies

Metabolic neuropathies are nerve disorders that occur with diseases that disrupt the chemical processes in the body.

Causes

Nerve damage can be caused by many different things. Metabolic neuropathy may be caused by:

• A problem with the body's ability to use energy, often due to a lack of enough nutrients (nutritional deficiency)
• Dangerous substances (toxins) that build up in the body

Diabetes is one of the most common causes of metabolic neuropathies. People who are at the highest risk for nerve damage (diabetic neuropathy) from diabetes include those who have:

Diabetic neuropathy

Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complication of diabetes.

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• Damage to the kidneys or eyes
• Poorly controlled blood sugar
• The longer one has diabetes, the more likely they are to get neuropathy

Other common causes of metabolic neuropathies include:

• Alcohol use disorder (alcoholic neuropathy)

  Alcoholic neuropathy

  Alcoholic neuropathy is damage to the nerves that results from excessive drinking of alcohol.

  

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• Low blood sugar (hypoglycemia)

  Hypoglycemia

  Low blood sugar is a condition that occurs when the body's blood sugar (glucose) decreases and is too low. Blood sugar below 70 mg/dL (3. 9 mmol/L) i...

  

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• Kidney failure
• Inherited conditions, such as porphyria

  Porphyria

  Porphyrias are a group of rare inherited disorders. An important part of hemoglobin, called heme, is not made properly. Hemoglobin is a protein in ...

  

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• Severe infection throughout the body (sepsis)

  Sepsis

  Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.

  

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• Thyroid disease
• Liver disease
• Vitamin deficiencies (including vitamins B12, B6, E, and B1)

  B12

  Vitamin B12 is a water-soluble vitamin. Water-soluble vitamins dissolve in water. After the body uses what it needs of these vitamins, leftover amo...

  

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  B6

  Vitamin B6 is a water-soluble vitamin. Water-soluble vitamins dissolve in water so the body cannot store them. Leftover amounts of the vitamin leav...

  

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  E

  Vitamin E is a fat-soluble vitamin. Your body stores vitamin E in fatty tissue and the liver.

  

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  B1

  Thiamin is one of the B vitamins. The B vitamins are a group of water-soluble vitamins that are part of many of the chemical reactions in the body....

  

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Some metabolic disorders are passed down through families (inherited), while others develop due to various diseases.

Symptoms

These symptoms occur because nerves cannot send proper signals to and from your brain:

• Difficulty feeling in any area of the body
• Difficulty using the arms or hands
• Difficulty using the legs or feet
• Difficulty walking
• Pain, burning feeling, a pins and needles feeling or shooting pains in any area of the body (nerve pain)
• Weakness in the face, arms, legs, or other areas of the body
• Dysautonomia, which affects the autonomic (involuntary) nervous system, resulting in symptoms such as rapid heart rate, exercise intolerance, low blood pressure when standing, abnormal sweat patterns, stomach problems, abnormal functioning of the pupils of the eye, and poor erection

These symptoms often start in the toes and feet and move up the legs, eventually affecting the hands and arms.

Exams and Tests

Your health care provider will examine you and ask about your symptoms.

Tests that may be ordered include:

• Blood and urine tests
• Electrical test of the muscles (electromyography or EMG)

  Electromyography or EMG

  Electromyography (EMG) is a test that checks the health of the muscles and the nerves that control the muscles.

  

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• Electrical test of nerve conduction

  Nerve conduction

  Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. This test is done along with electromyography (EM...

  

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• Nerve tissue biopsy

  Nerve tissue biopsy

  A nerve biopsy is the removal of a small piece of a nerve for examination.

  

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Treatment

For most metabolic neuropathies, the best treatment is to correct the metabolic problem.

Vitamin deficiencies are treated with diet or with vitamins by mouth or by injection. Abnormal blood sugar level or thyroid function may need medicines to correct the problem. For alcoholic neuropathy, the best treatment is to stop drinking alcohol.

In some cases, pain is treated with medicines that reduce abnormal pain signals from the nerves. In some cases, lotions, creams, or medicated patches can provide relief.

Weakness is often treated with physical therapy. You may need to learn how to use a cane or walker if your balance is affected. You may need special ankle braces to help you walk better.

Support Groups

These groups can provide more information on neuropathy:

• Neuropathy Action Foundation -- www.neuropathyaction.org
• The Foundation for Peripheral Neuropathy -- www.foundationforpn.org

Outlook (Prognosis)

The outlook mainly depends on the cause of the disorder. In some cases, the problem can easily be treated. In other cases, the metabolic problem cannot be controlled, and nerves may continue to become damaged.

Possible Complications

Complications that may result include:

• Deformity
• Injury to feet
• Numbness or weakness
• Pain
• Trouble walking and falls

Prevention

Maintaining a healthy lifestyle can reduce the risk for neuropathy.

• Avoid excess alcohol use.
• Eat a balanced diet.
• Quit smoking.
• Visit your provider regularly to find metabolic disorders before neuropathy develops.

If you have neuropathy in your feet, a foot doctor (podiatrist) can teach you how to inspect your feet for signs of injury and infection. Proper fitting shoes can lessen the chance of skin breakdown in sensitive areas of the feet.