Patient 11, A 70 year-old male was admitted to the hospital with gangrene of the right foot gangrene. He had a history of type 2 diabetes for 10 years, with of sensation in hands and feet for 2 years. His blood glucose was not controlled very well. Physical examination revealed that him temperature 37.4ˇăC, BP 160/100mmHg, and his toes on his right foot with a dark color gangrene on the big toe with an ulcer, and foul smelling exudate. There were also two erythematous lesions (9.5x8cm and 8x9.5cm) on the right foot. The foot was warm but pulseless, and the gangrene was grade III.
Laboratory tests showed WBC 11.3 x10 9 /L, polys 89.3%, ketones in urine (+++), blood glucose 19.8mmol/L, creatinine 127.5 umol/L and foot X-ray revealed no osteomyelitis. Ultrasound suggested arteriosclerosis in the vessels of the lower limbs. Also diabetic retinopathy (grade 1) and cataract were found.
The treatment included basic and local treatment. Basic treatment involved blood glucose control with insulin Novo R and N, diet and excise. Antibiotics therapy and support medications were also given. Medication for improving the local blood flow was also given. Local surgery to the lesions of the foot helped recovery from gangrene. After one week of treatment, temperature, BP, WBC were normal. And ketones were negative. Fasting blood glucose was maintained at 6-8mmol/L with insulin. The infected lesions were becoming dry and less swollen. One month later, when all other infected areas were controlled the big toe was amputated. After two month therapy, the lesions were cured and patient was discharged from the hospital. |
