Critical Care Neuropathy CIP

Synonyms:

a.k.a. critical illness polyneuropathy CIP

Diagnosis:

This is a clinical diagnosis supported by electrodiagnostic features

Clinical features:

Severely ill patient >1 week in ICU, acute weakness (distal initially), areflexia, flaccid tetraparesis, atrophy, difficulty weaning from ventilator,

Findings on investigations:

+NCS/EMG:

  • EMG/NCS: reduced CMAP amplitude, reduced SNAP amplitude, normal velocities, no conduction block, fibrillations.

NCS:

  • Axonal
  • CMAP: decreased amplitude, normal conduction velocity
  • SNAP: decreased or normal amplitude. Normal Sensory conduction velocity

EMG:

  • fibrillation potentials, positive waves

Other tests:

  • CSF: normal

Pathology:

Axonal loss
No inflammation in nerves

Treatment:

Prevention: Better glycemic control reduces risk of critical care neuropathy.

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