Damage to peripheral nerves causing distal sensory ± motor loss; commonest is diabetic.
Etiology
- • Diabetes, alcohol, B12 deficiency
- • Drugs (chemo, isoniazid, amiodarone)
- • CKD, hypothyroidism, vasculitis, hereditary
History taking
- • Stocking-glove paraesthesia, burning pain
- • Weakness, falls, foot ulcers
Examination
- • 10g monofilament, vibration, ankle reflex
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • HbA1c, B12, TSH, U&E, LFT
- • Consider NCS / EMG if asymmetrical or rapid
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Amitriptyline 10–75 mg ON or duloxetine 30–60 mg OD or gabapentin 300 mg TDS / pregabalin 75 mg BD
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Foot care critical in diabetes — annual screen
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
