May have a malabsorption syndrome or nutritional intake deficiency.
Polyneuropathy is common manifestation (in 9%) - most are mild and only occur after many years of excessive drinking (usually > 100gms alcohol/day). Not clear if neuropathy is due to nutritional deficiencies or the direct toxic effect of the alcohol on the nerves or both. All other features of alcoholism are present. If mild mild (often unnoticeable) sensory impairments in feet and legs; some loss of muscle bulk in lower limbs; reduced distal tendon reflexes. If more severe weakness, parathesia and pain (dull ache and burning in feet); weakness may cause foot drop
Management – stop alcohol consumption and start adequate diet (often difficult) slow improvement
Thiamine/Vitamin B1 deficiency (Beriberi) neuropathy:
Often associated with alcoholism in Western counties and poor diets in other countries.
Begins with symmetric loss of sensation in lower limbs; legs feel heavy and can be painful (‘burning feet’); muscle cramps; ataxia; systemic symptoms (lethargy, anorexia, nausea, vomiting)
Pyridoxine/Vitamin B6 deficiency neuropathy:
Bilateral distal parathesias, that spread proximally; often a burning sensation in foot; hyporeflexia (especially achilles). Pyridoxine deficiency very rare.