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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

1
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]
2
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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