Ephedrine: A New Treatment for Diabetic Neuropathic Oedema

Edmonds, M E; Archer, A.G.; Watkins, P J

doi:10.1016/s0140-6736(83)92809-x

Cited by 49 publications

(15 citation statements)

References 13 publications

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“…Neuropathic oedema decreases when patients are given ephedrine [21] and it is possible that nutritive blood flow, impaired by arteriovenous shunting, might be improved. Many patients and physicians know that pain can be diminished by cooling the feet [9,22] and unsatisfactory attempts have been made in the past to reduce blood flow [23].…”

Section: Discussionmentioning

confidence: 99%

Blood flow patterns in painful diabetic neuropathy

1984

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Summary.Peripheral blood flow is known to be qualitatively increased in diabetic patients with neuropathy. We have measured the actual blood flow in the feet of diabetic patients with neuropathy using non-invasive mercury strain gauge plethysmography and Doppler sonogram techniques and shown that it is increased on average five times above normal at an ambient temperature of 20 ~ -22 ~ Moreover, reduction of this high flow by sympathetic arousal stimuli proved possible in those with severe painful neuropathy contrasting strongly with failure to reverse it in those with severe non-painful sensory neuropathy. Reduction of blood flow was associated with reduction in neuropathic pain. We studied 22 diabetic patients with severe sensory neuropathy and eight with painful neuropathy. High resting foot blood flows were demonstrated in both groups with neuropathy. The big toe flow in those with severe sensory neuropathy was 29.3 + 9.2 ml. rain-1. 100m1-1 (mean+-SD) and in the painful neuropathy group, 25.9+_7.5, compared with 5.2+2.4ml.min -1. 100m1-1 in the non-diabetic control subjects (p<0.001). High foot skin temperatures were also recorded in the groups with neuropathy, reflecting the high blood flow. The subjects with painful neuropathy retained the ability to constrict peripheral blood vessels in response to arousal stimuli, and reduce peripheral flow on average by 32% compared with the patients with sensory neuropathy who responded on average by only 10%. The demonstration of a peripheral sympathetic defect, responsible for the high blood flow and the potential reversal of such flow in painful neuropathy may be important in our further understanding of the aetiology of such pain and its treatment.Key words: Diabetes mellitus, peripheral blood flow, sensory neuropathy, painful neuropathy, peripheral sympathetic neuropathy.During the nineteenth century, the feet of diabetic patients with peripheral neuropathy were observed to be hot and erythematous [1] and the blood flow in such feet was considered to be increased. This increase is now thought to be due to the dilation of denervated arteriovenous shunts [2-9] normally controlled by sympathetic nerves.Measurement of actual blood flow in diabetic neuropathic feet has only been undertaken in one previous study [10]. Blood flow was not found to be increased in neuropathic subjects probably because the studies were conducted by waterbath plethysmography at 32~ causing vasodilatation and increased flow in the control subjects.The aim of this study was to measure the magnitude of resting foot blood flow in a group of diabetic patients with severe sensory neuropathy and to discover whether the hot, burning foot, so characteristic of distal painful neuropathy, also has a high resting flow resulting from a peripheral sympathetic defect. In addition, the sympathetic responses of both types of neuropathy were tested to discover whether either retained the ability to reduce peripheral flow by vasoconstriction, and whether any benefits might result from this. Subjects and metho...

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Section: Discussionmentioning

confidence: 99%

Blood flow patterns in painful diabetic neuropathy

1984

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“…The 30:15 RR interval (RRI) and its ratio (RRIR) of less than one was considered abnormal 11 . In normal individuals, acceleration of the heart rate is maximal up to 15 beats after standing and slows to near supine rate at 30 beats.…”

Section: Tests Of Parasympathetic Dysfunctionmentioning

confidence: 99%

“…Peripheral autonomic neuropathy may be a pre-requisite for the development of foot ulceration 9,10 . Sympathomimetic drugs have a benefi cial effect on pedal oedema 11 . Diabetic patients with pupillary abnormalities have diffi culty driving at night.…”

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confidence: 99%

Autonomic nervous system evaluation in Type 2 diabetic patients and effect of its duration

Acharya

Shrestha

et al. 2013

J. Kathmandu Med. Coll.

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Introduction: Dysfunction of the autonomic nervous system is common in diabetic patients. Presence of autonomic dysfunction should alert the physicians of its serious consequences that require timely preventive measures. Objectives: This study was done to fi nd out the autonomic nervous system involvement in Type 2 diabetic patients and to see its relation with the duration of diabetes. Methods: This was a hospital based cross-sectional study. All consecutive diabetic patients of both genders attending Kathmandu Medical College and a private clinic, Temple of Healing were included. A battery of six well validated and accepted autonomic nervous system evaluation tests were done to evaluate the autonomic function in 245 Type 2 diabetic patients. Results: Prevalence of autonomic dysfunction was found to be 71.02% with 58.78% patients having mild autonomic dysfunction and 12.24% having moderate dysfunction. Severe autonomic dysfunction was detected in none of the patients. Parasympathetic dysfunction was much more common than sympathetic dysfunction (68.16% vs. 17.96%). No association was found between autonomic dysfunction and duration of diabetes. Conclusions: Autonomic dysfunction is very common in diabetics and can be detected by simple tests. Timely detection of autonomic dysfunction in diabetic patients is advised so that its preventive measures can be effective.

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“…The oxygen tension of the blood in these veins is typically raised [ 16 ] . The increasing blood fl ow brought about by autonomic neuropathy can sometimes result in neuropathic oedema, which is resistant to treatment with diuretics but may occasionally respond to treatment with ephedrine [ 17 ] .…”

Section: Clinical Diagnosis: Examinationmentioning

confidence: 99%

Diabetic Polyneuropathy

Tesfaye

2012

The Diabetic Foot

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Diabetic neuropathy is a common complication of diabetes and a cause of considerable morbidity and increased mortality. Diabetic neuropathy is not a single entity but encompasses several neuropathic syndrome. However, by far, the commonest presentation of neuropathy in diabetes is chronic distal symmetrical polyneuropathy also commonly known as diabetic peripheral neuropathy (DPN). The Toronto Diabetic Neuropathy Consensus Panel defi ned DPN as "a symmetrical, length-dependent sensorimotor polyneuropathy attributable to metabolic and microvessel alterations as a result of chronic hyperglycemia exposure and cardiovascular risk covariates. An abnormality of nerve conduction (NC) tests, which is frequently subclinical, appears to be the fi rst objective quantitative indication of the condition. The occurrences of diabetic retinopathy and nephropathy in a given patient strengthen the case that the polyneuropathy is attributable to diabetes". This chapter covers all the neuropathic syndromes encountered in diabetes mellitus, although the main focuses are (1) DPN, which is the main initiating factor for foot ulceration and a cause of troublesome chronic painful neuropathic symptoms, and (2) autonomic neuropathy, often associated with DPN that can involve almost all the systems of the body and may have devastating consequences, such as sudden death.

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Ephedrine: A New Treatment for Diabetic Neuropathic Oedema

Cited by 49 publications

References 13 publications

Blood flow patterns in painful diabetic neuropathy

Blood flow patterns in painful diabetic neuropathy

Autonomic nervous system evaluation in Type 2 diabetic patients and effect of its duration

Diabetic Polyneuropathy

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