Urgent considerations

See Differentials for more details

Polyneuropathies that progress over hours to days require inpatient evaluation. These patients may be at risk for neurogenic respiratory failure, autonomic failure, and cardiac arrhythmias.

Diagnostic considerations include:

  • Guillain-Barre syndrome

  • Toxin-induced polyneuropathy (e.g., arsenic, thallium, lead)

  • Porphyric polyneuropathy

  • Paraneoplastic neuropathy.

Interventions should include:

  • Admission to a monitored ward or intensive care unit if there is respiratory insufficiency or speech/swallowing problems.

  • Frequent measurements of forced vital capacity and maximum inspiratory force (arterial blood gas measurements and pulse oximetry are both insensitive for detecting incipient neuromuscular respiratory failure; mechanical failure typically precedes hypercapnia, both of which precede hypoxia).

  • Nerve conduction studies and electromyography to confirm and characterise polyneuropathy.

  • Urgent intubation and ventilation is required for patients in respiratory failure. Intubation and ventilation should be considered in patients with bulbar dysfunction, vital capacity <20 mL/kg, bilateral facial palsy, autonomic dysfunction, or rapid disease progression.[41]

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