Neuropathy, Autonomic

Christine Ramos Camacho, MD, MS, Karla C. Acosta, MD, MPH and Maria Montanez Villacampa, MD Reviewed 06/2019

BASICS

DESCRIPTION

Any neuropathic process that has predominant effects on the autonomic nervous system
Process targets small unmyelinated or lightly myelinated peripheral nerves.
Most of the time, it is...

DIAGNOSIS

HISTORY

Orthostatic light-headedness or syncope
Early satiety
Nausea, postprandial vomiting
Hyperhidrosis or anhidrosis
Gustatory (with meals) sweating
Constipation or diarrhea
Erectile dysfunction...

TREATMENT

GENERAL MEASURES

For diabetic autonomic neuropathy, evidence of intensive glycemic control is strong for type 1 diabetes but less so for type 2.
Volume repletion up to 10 L/day and salt replet...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

For diabetic patients, autonomic neuropathy is a marker for increased cardiovascular and overall mortality, so patients should follow up more frequently.

DIET

Diet...

REFERENCES

Azhary H, Farooq MU, Bhanushali M, et al. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010;81(7): 887–892. [View Abstract on OvidMedline]

Ge X, Pa...

ADDITIONAL READING

Verrotti A, Prezioso G, Scattoni R, et al. Autonomic neuropathy in diabetes mellitus. Front Endocrinol (Lausanne). 2014;5:205. [View Abstract on OvidMedline]

CODES

ICD10

G90.9 Disorder of the autonomic nervous system, unspecified
E11.43 Type 2 diabetes w diabetic autonomic (poly)neuropathy
E10.43 Type 1 diabetes w diabetic autonomic (poly)neuropathy
E13.43 Oth...

CLINICAL PEARLS

Autonomic effects are often subclinical in peripheral neuropathies.
A resting HR of >90 beats/min, especially if persistent, should increase concern for autonomic neuropathy.
Erectile...

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