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Case On Peripheral Neuropathy

The 68-year old male patient presented with burning and tingling sensations in his feet along with difficulty walking due to peripheral neuropathy. Laboratory tests confirmed hyperglycemia and vitamin B12 deficiency. He was diagnosed with peripheral neuropathy secondary to long-standing diabetes and vitamin B12 deficiency, and treated with repaglinide, vitamin B12 injections, and lifestyle modifications.

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321 views28 pages

Case On Peripheral Neuropathy

The 68-year old male patient presented with burning and tingling sensations in his feet along with difficulty walking due to peripheral neuropathy. Laboratory tests confirmed hyperglycemia and vitamin B12 deficiency. He was diagnosed with peripheral neuropathy secondary to long-standing diabetes and vitamin B12 deficiency, and treated with repaglinide, vitamin B12 injections, and lifestyle modifications.

Uploaded by

dimple alluri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CASE PRESENTATION

ON
PERIPHERAL
NEUROPATHY
DEMOGRAPHICS

• Patient Name : Mr.CV


• 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
1.Vitamin 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
• https://www.diabetesjournals.org/
• https://www.aanem.org/Patients/Muscle-and-Nerve-
Disorders/Peripheral-Neuropathy
• https://www.medscape.com/pharmacists
• https://www.micromedexsolutions.com/
• https://www.drugs.com/

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