Peripheral polyneuropathy complicating conditions of sepsis and multi-organ failure

We studied five patients who developed evidence of acute mainly motor peripheral polyneuropathy complicating a condition of prolonged sepsis associated with multi-organ failure. In the electrophysiological studies we observed normal motor and sensory nerve conduction velocities but there were drops in the amplitudes of the compound action potentials in the muscles and sensory peripheral nerves as well as high denervation activity on electromyography. Analytical studies of cerebrospinal fluid and blood did not show any findings of interest except for a deterioration in the nutritional parameters without specific deficiencies. The immunological and microbiological studies failed to determine factors related to the development of polyneuropathies. Nerve and muscle biopsies showed axonal neuropathy with some demyelination changes and reinnervation. Three patients survived the critical state and were re-examined presenting a moderate improvement in the neurological condition accompanied with signs of reinnervation in the electromyographic study. Given the absence of known factors implicated in the development of acute polyneuropathies in our patients, we suggest that the relevant disorders of the cellular metabolism observed in patients with prolonged sepsis aggravated by the defective nutritional condition, may be factors related to the development of these polyneuropathies.