CASE PRESENTATION
ON
PERIPHERAL
NEUROPATHY
DEMOGRAPHICS
• Patient Name : [Link]
• Age: 68 years
• Gender: Male
• Weight: 75Kg
• Height: 5 feet 5 inches
• BMI: 27.51kg/m2
COMPLAINTS ON ADMISSION
• Burning and tingling
sensation in his feet.
• Walking was becoming a
more of chore.
• Excessive sweating - Foot
• No chest pain, SOB, fever
and hematuria.
• Gained 3kgs.
ON EXAMINATION
• Patient is conscious and
oriented
• CVS: S1S2 +
• R/S : Clear
• P/A : Soft
• Hyperthesia of both feet
• His reflexes were
normal
PHYSICAL EXAMINATION
Description Day1
BP(mmHg) 140/110
RR(breaths/min) 22
PR(bpm) 72
Temp( ⁰F) 100
HISTORY OF PATIENT
• PAST MEDICAL HISTORY
1. Type II Diabetes Mellitus
Medication: NA
3 year history of impaired glucose intolerance.
2. HTN
Medication : Tab Enalapril 5mg
• PAST MEDICAL CHECKUP
No dyslipidemia
Echocardiogram : Normal
• Alcohol : Alcoholic
• Smoking : Stopped 20years ago
• Occupation : Retired government officer
• FAMILY HISTORY :
1. Mother : HTN
2. Father : Diabetes mellitus type 2
LABORATORY INVESTIGATIONS
Description Normal Range Day1
RBC 4.7-6.1millioncells/mcl 4.6
WBC 4000-11000cell/ml 10000
Haemoglobin 12-17g/dl 12g/dl
Platelets 150-400 x 109/L 200
Creatinine 0.6-1.3mg/dl 0.7
BUN 7-18mg/dl 14
RBS
Description VALUE
Fasting Blood Sugar 140mg/dL
Post Prandial 200mg/dL
HbA1C 7.2%
INTERPRETATION : HYPERGLYCEMIA
SUBJECTIVE:
Burning and tingling sensation in his feet.
Walking was becoming difficult.
Excessive sweating - Foot
Gained 3kgs
OBJECTIVE:
Impaired glucose tolerance.
ASSESSMENT
From subjective and
objective evidence the
patient was diagnosed
with “Peripheral
Neuropathy”
TREATMENT REGIMEN
• REPAGLINIDE
0.5mg BID
• Continues blood glucose level monitoring
every 2 weeks
• Physical exercise
FOLLOW UP
• Within few weeks blood glucose levels returned to
normal
• No hypoglycemic events
2 months later......
• He reported fatigue was increased and excessive
sweating was continued
• Loss of appetite
• Foot pain
• Slight ataxia was noted
LABARATORY INVESTIGATION
Description Normal Range Day1
Hemoglobin 14-18g/dL 10
PCV 41-59% 45.3%
MCV 76-96fL 105
MCH 27-32pg/ml 34pg/ml
Serum Iron 76-198mcg/dL 85
Vitamin B12 200-900pg/mL 150
Folate 2-20ng/mL 19
X-ray : No malignancy
Colonoscopy : Normal
TREATMENT
• Vitamin B12
(Injection) 100 mcg IM or deep subQ injection daily
for 7days.
• Folic acid 1mg/day orally
Followup....
Little improvement in neurological symptoms
Fatigue decreased
PHARMACIST INTERVENTIONS
• ADVERSE DRUG REACTION:
No ADRs are found in this patient
• DRUG INTERACTIONS:
No Interactions
1. Drug without indication
Folic acid
2. Indication without drug
Hydrophorosis
Suggestive Drug : Antiperspirant lotion
3. Incorrect dosage
100 mcg IM or deep subQ injection daily for 6 or 7
days;
give same amount on alternate days for 7 doses;
then every 3 to 4 days for another 2 to 3 weeks;
then 100 mcg monthly for life or 500mcg orally OD.
PATIENT COUNSELLING
DISEASE
Peripheral Neuropathy - Symptom
Nerve damage
Longest nerve
Foot and toes
Correct the underline cause
Risk Factors - Alcohol intake
Diabetes
Vitamin B12 deficiency
Age
• Vitamin B12 deficiency -age, poor intake and/or due
to alochol intake
• Maintain a controlled blood sugar
• Impair sensation and blood flow results from blood
sugar damage
• Poor physical activity will increase the risk of
oedema or skin changes which results in increase of
damage in the limbs.
• Injuries that would normally cause pain do not cause
pain if you have neuropathy.
• Avoid too much pressure
on the affected leg and
make use of clean socks or
foot wear
• Inspect your foot daily and
must check regularly your
feet for signs of injury.
• Keep clinical observations
regularly by monitoring
blood sugar, blood
pressure, limb neuropathy
which leads to ulcer
symptoms.
EAT MORE EAT LESS
• Healthy fats from nuts, olive oil, • Trans fats from partially
fish oils, flax seeds, or avocados hydrogenated or deep-fried foods
• Fruits and vegetables—ideally • Packaged and fast foods, especially
fresh, the more colorful the those high in sugar, baked goods,
better; whole fruit rather than sweets, chips, desserts
juices • White bread, sugary cereals,
• High-fiber cereals refined pastas or rice
• Fish and shellfish, organic • Processed meat and red meat
chicken • Low-fat products that have
• High-quality protein such as replaced fat with added sugar, such
eggs, beans, low-fat dairy, and as fat-free yogurt
unsweetened yogurt
OVER WEIGHT
• Category: overweight
• Weight reduction : 7-8Kgs
• Improve your physical activity
• Foods :
Have them : Fresh veggies, fruits,
oats, barley, sprouts
Avoid : Beverages, refined grains,
Fried foods, cheese, butter and fast foods
DRUG COUNSELLING
[Link] B12
• side effects : Diarrhea, Mild skin itching.
• oral : avoid alcohol while taking this drug.
2. Repaglinide
• 15min before lunch and dinner
• side effects : Diarrhea and athralgia
• Do not take this medicine if you skip a meal.
storage : Store the medicine in a closed container at room
temperature, away from heat, moisture, and direct light.
Away from children.
GLUCOMETER
REFERENCES
• [Link]
• [Link]
Disorders/Peripheral-Neuropathy
• [Link]
• [Link]
• [Link]
