This case study on Diabetes Complications presented by Shivank Agrawal (Doctor of Pharmacy ) will help understand about the critical insights regarding treatment of Diabetes, its complications and its management.
Title: Case Study: Management of Diabetic Cellulitis
Introduction:
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia, leading to various complications including skin infections such as cellulitis. Cellulitis is a bacterial infection affecting the skin and underlying tissues, often exacerbated in diabetic patients due to impaired immune function and compromised blood circulation. This case study focuses on the management of diabetic cellulitis in a patient presenting with typical symptoms.
Treatment Plan:
Antibiotic Therapy: Initiation of empiric antibiotic therapy with oral cephalexin to cover common pathogens such as Staphylococcus aureus and Streptococcus species. The choice of antibiotics was based on local antibiogram data and the patient's clinical response.
Glycemic Control: Optimization of blood glucose levels through insulin therapy to enhance immune function and promote wound healing. Regular monitoring of blood glucose levels was implemented to adjust insulin doses accordingly.
Wound Care: Daily wound cleansing with saline followed by application of topical antimicrobial agents and sterile dressings to prevent secondary infection and promote granulation tissue formation.
Patient Education: Comprehensive education regarding diabetic foot care, including the importance of daily foot inspections, proper footwear, and prompt management of any foot injuries to prevent future complications.
Conclusion:
This case highlights the importance of prompt diagnosis and appropriate management of diabetic cellulitis to prevent complications and improve patient outcomes. A collaborative approach involving pharmacists, physicians, and other healthcare professionals is essential for the comprehensive care of diabetic patients with skin infections. Emphasis on glycemic control and wound care plays a crucial role in preventing recurrent infections and promoting overall health in diabetic individuals.
Role of Clinical Pharmacist in Management of Diabetes Complications.
Pharmacists play a crucial role in the management of diabetes cellulitis, contributing significantly to patient care through their expertise in medication therapy management, patient education, and collaborative healthcare. Their involvement spans various aspects of the management process:
Medication Management:
Antibiotic Selection: Pharmacists assist in choosing appropriate antibiotics based on the patient's clinical presentation, comorbidities, and potential drug interactions.
Dosing and Administration: They ensure proper dosing regimens, considering factors such as renal function and drug allergies, to optimize therapeutic efficacy and minimize adverse effects.
Monitoring: Pharmacists monitor the patient's response to antibiotic therapy, inc
2. NAME: Mrs Puja Shethi
AGE: 35 years
GENDER: Female
IPD No: 74987
UHID No: 20230074987
WARD: General Surgery
DOA: 04/01/2024
DOD: not yet discharged
DEMOGRAPHIC FEATURES
3. COMPLAINTS ON ADMISSION
1.Blackening of Leftside Toe from 1 week
2.Left Foot Swelling till Ankle
3.Fever with Chills since 6 days
4. Headache since 6 days
4. SUBJECTIVE EVIDENCE
MEDICAL HISTORY: Pre-medical conditions-type-1Diabetes (since 6-7 years) ,
Clinical procedures- RIGHT FOOT STSG (7/10/23)
.
MEDICATION HISTORY: Past medications being consumed-
Tab .Metformin (1.5gm) 1-1-1 (6-7 years)
SOCIAL HISTORY: Diet- Mixed, Social habit-None, Occupation-Housewife
FAMILY HISTORY: Significant history of DM and HTN.
7. ROUTINE BIOCHEMICAL INVESTIGATION
ALANINE TRANSAMINASE :– 159 U/L (VERY HIGH)
ALKALINE PHOSPHATASE :– 143 U/L ( VERY HIGH)
ALBUMIN :– 2.1 g/dl (low)
PANCREATIC FUNCTION TEST :-
AMYLASE- NORMAL
LIPASE- NORMAL
8. ROUTINE BIOCHEMICAL INVESTIGATION
RFT:- Normal value
Creatinine-0.65
PFT: Normal
ELECTROLYTES:-
Sodium-132.70 (low)
Potassium-5.18 (High)
LIPID PROFILE: Not done
THYROID FUNCTION TEST:-
TSH- 4.281 (within Normal range) but in our case as patient is diabetic it will be considered mildly higher.
10. OTHER CLINICAL INVESTIGATIONS
CULTURE SENSITIVITY TEST:- Sample- Urine
Result- No pus cells were seen/ No growth seen
USG:-
NECK:- NORMAL
ABDOMEN & PELVIS :- NORMAL
THORAX:- NORMAL
X- RAY: APPEARS NORMAL
ECG: NOTHING OF SIGNIFICANCE
11. OTHER CLINICAL INVESTIGATIONS
LOWER LIMB ARTERIO-VENOUS DOPPLER STUDY-
Impression:- Lower 1/3rd of both anterior tibial veins show color filling only on distal augmentation
on CFM mode.
P/O- Stasis
12. PROVISIONAL & FINAL DIAGNOSIS
PROVISIONAL DIAGNOSIS: a) Diabetic foot gangrene
b) Left Foot Cellulitis
FINAL DIAGNOSIS: Left Foot Cellulitis in k/c/o DM
13. ASSESMENT OF CURRENT THERAPY
GENERIC
NAME
BRAND NAME DOSE FREQUENCY ROA DATE
STARTED
DATE ENDED
Amoxicilli
n+Clavula
nic Acid
Pantoprazo
le
Ultram
Emset
Inj
.Augmentin
Inj.Pantop
Inj.Tramad
ol
Inj.Ondanse
tron
1000mg+
200 mg
40mg
100mg
8 mg
1-1-1
1-1-1
1-0-1
1-1-1
IV
IV
IV
IV
04/01/2024
04/01/2024
04/01/2024
04/01/2024
29/01/24
29/01/24
29/01/24
29/01/24
14. ASSESMENT OF CURRENT THERAPY
GENERIC
NAME
BRAND NAME DOSE FREQUENCY ROA DATE
STARTED
DATE ENDED
Paracetam
ol
Dextrose
5%
Insulin
MVBC
Vitamin C
Inj.PCM
IVF D5
s/c Lispro
T.MVBC
T.Vitamin
500 mg
5% v/v
Units acc to
RBS
500 mg
1-1-1
1-1-1
1-1-1-1
1-0-1
1-0-1
IV
IV(slowly)
S/C
oral
oral
04/01/24
04/01/24
04/01/24
Post operati
ve
Post operati
29/01/24
29/01/24
29/01/24
29/01/24
29/01/24
15. ASSESMENT OF CURRENT THERAPY
GENERIC
NAME
BRAND NAME DOSE FREQUENCY ROA DATE
STARTED
DATE ENDED
Metformin T.Gluconor
m
500mg 1-1-1 oral 04/01/24 continue
16. AMOXICILLIN+CLAVULANIC ACID (1000mg + 200mg) TID
AMOXICILLIN:
Category: Aminopenicillin
Indication: Surgical Prophylaxis
MOA: acts on susceptible bacteria during multiplication stage by inhibiting cell wall mucopeptide biosynthesis.
Std dose:500 mg BD
ADR: Mucocutaneous candidiasis, anaphylactic reactions, Anaemia , Diarrhoea, Bloating .
CONTRAINDICATIONS: Documented hypersensitivity to penicillins, cephalosporins, imipenem
CLAVULANIC ACID:
Category: Beta-lactamase inhibitor
Indication :Surgical Prophylaxis
MOA: Clavulanic acid contains a beta-lactam ring that binds to the beta-lactamase active site and inactivates the
enzyme.
STD dose: 125 mg
ADR: same as amoxicillin
CONTRAINDICATIONS: hypersensitivity and anaphylaxis to either component.
17. DRUG INTERACTIONS
FINDINGS ASSESSMENT RESOLUTION MONITORING
METFORMIN <>
INSULIN LISPRO
Both can
induce hypoglycemia ,
therefore pharmacody
namic synergism.
Patient should be admi
nistered with Dextrose
5% solution
Monitor Closely for
Hypoglycemic Shock
18. PLAN
SHORT TERM GOALS:
1. To prevent further spreading of infection.
2. To prevent further amputation.
3. To allow for complete healing of surgical wound.
LONG TERM GOALS:
1. To improve quality of life of patient
2. To progressively lower glucose levels and maintain them within
Range.
3. To improve mental health of patient.
20. POINTS TO PHYSICIAN
1. A combination of antibiotics should be considered for
surgical prophylaxis i.e along with augmentin ,ceftriaxone
could be considered.
2. Cultural sensitivity could be done to check for resistance.
3. Antiplatelet therapy could be considered as platelets are
higher
4. Psychiatric reference could possibly be considered.
5. Regular monitoring for hypothyroidism
21. POINTS TO PATIENT
Patient counselling points related to:
Disease: About type-1 Diabetes, how it leaded to diabetic
foot infection.
Drug Therapy: use of amoxicillin for infection control, insulin
& metformin for glucose control.
Life Style Modifications:
Importance of foot hygiene.
Psychiatric counselling for anxiety reduction.
