Nutritional Neuropathies

Most nutritional neuropathies involve one of the B-complex vitamins. Patients at risk for these neuropathies usually have chronic alcoholism, malabsorption syndrome, eating disorder, or unusual diet (food faddist). It presents as a symmetric polyneuropathy with burning in the feet. Weakness, atrophy, and hypoactive reflexes may also occur.

Alcoholic neuropathy is caused from inadequate intake and poor absorption. Treatment with multivitamin supplementation is usually adequate but may take time to be effective. Thiamine (vitamin Bj) deficiency, or beriberi, is seen most often with chronic alcoholism. It may present as a distal polyneuropathy or as a more serious Wernicke-Korsakoff encephalopathy, with mental status changes. In the latter case, intramuscular thiamine (100 mg/day) is preferred initially over oral administration. Pyridoxine (vitamin B6) deficiency can be associated with the use of dapsone or iso-niazid, which interfere with vitamin B6 metabolism. Prevention requires supplementation with 50 mg of pyridoxine three times daily. Prolonged intake of pyridoxine of more than 2 g/day has also been associated with sensory neuropathy (Rostami, 1995). Vitamin B12 deficiency may present only with vague paresthesias. Determining the serum vitamin B12 level is the best way to assess a patient when this problem is suspected, because abnormal RBC indices may not be apparent until irreversible neurologic symptoms have already occurred.

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