SUN-279 Peripheral Neuropathy in an Adolescent following Severe Diabetic Ketoacidosis: A Case Study with Review of the Literature

Objective We report a case of painful pedal neuropathy in a young person after severe diabetic ketoacidosis, which resolved with alpha lipoic acid. We review the literature on the use of alpha lipoic acid for this rare neuropathy. Background Peripheral neuropathy frequently complicates uncontrolled diabetes, but is rarely seen in pediatrics. Alpha lipoic acid may help prevent diabetic peripheral neuropathy, possibly by improving blood glucose levels. A 16-year-old girl, with recent 40 pound weight loss, was found altered. In the emergency room she responded only to sternal rub. Blood pH was 6.6, bicarbonate was 2 mEq/L and blood glucose was over 700 mg/dL. She was diagnosed with new onset type 1 diabetes and transferred to an intensive care unit where she received intravenous insulin and 3% hypertonic saline for neuroprotection. In the hospital she wore sequential compressive devices to prevent deep vein thrombosis, and transitioned to compression stockings. Despite this her feet were edematous. She recovered well, but after discharge, despite excellent blood sugar control, her feet became painful, erythematous and edematous. Pain was exacerbated by light touch. Furosemide reduced edema but did not improve pain. Hydrocodone did not improve pain. Ambulation was extremely painful. Reflexes were intact but strength testing was limited by pain. Results Gabapentin, 100 mg three times a day, reduced but did not resolve her pain. After one week, she started alpha lipoic acid, 600 mg once a day, and this improved pain. Within 2 weeks she stopped gabapentin due to improvement. She continues on alpha lipoic acid. Conclusion Alpha lipoic acid rapidly improved pain in a young patient with profoundly painful bilateral pedal neuropathy. This supplement is being studied in diabetic neuropathy and other neurologic diseases, including multiple sclerosis. Further testing is needed, but providers should consider early treament of neuropathy in patients with severe diabetic ketoacidosis.