Suggested Pre-Referral Evaluation and Management Guidelines
Consider the following possibilities:
Consider alcohol, other nutritional, hormonal, toxic and inflammatory causes
Suggested Additional Test/Management Prior to Specialty Visit
CBC-PD, comprehensive metabolic panel, TSH, B12, WESR, ANA screen, SPEP with immunofixation, OGTT (Oral Glucose Tolerance Test) if not known to be diabetic, Alc if diabetic. Consider EMG if motor involvement or to establish presence of peripheral neuropathy (if in question) prior to referral. Consider HIV based on risk factors.
Patient Education/Information (includes preps)
Counsel about using nightlight at night, careful foot care.