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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Assess the signs and symptoms of diabetic foot infections

  • List the goals of treatment for patients with diabetic foot infections

  • Select appropriate nonpharmacologic and pharmacologic treatment regimens for patients presenting with diabetic foot infections

  • Identify adverse effects that may result from pharmacologic agents used in the treatment of diabetic foot infections

  • Develop a monitoring plan that will assess the safety and efficacy of the overall disease management of diabetic foot infections

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PATIENT PRESENTATION

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Chief Complaint

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"I cannot handle the pain in my foot anymore, I need a pain medication."

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History of Present Illness

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Ted Read is a 34-year-old male with type 1 DM who presents to the emergency department complaining of pain from an ulcer on the sole of his right foot. He reports having an ulcer in the past, but it healed after he borrowed a cream (unknown by the patient) from his friend. He has been using the same cream on this ulcer for the past week with no relief. He works in construction, so he needs to be on his feet all day, and today he could not handle the pain anymore. The ulcer started about 2 weeks ago. He thinks there was a rock in his shoe for an entire work day that started it. The pain has continuously worsened. He reports not regularly checking his feet. He is worried that this will affect his job since he is concerned about getting laid off.

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Past Medical History

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Type 1 DM diagnosed at the age 6

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History of one foot ulcer reported by the patient

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Family History

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Father is alive at age 56 with a history of suicide ideation. Mother is alive at age 54 with a history of hypothyroidism, HTN, and Addison's disease. He has 2 siblings who live locally. Medical history unknown.

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Social/Work History

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Single; has a child of age 4 years; works in construction; lately, reports an increase in stress due to concerns of getting laid off.

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Tobacco/Alcohol/Substance Use

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He admits to a few beers a night and maybe a little more on the weekends; no illicit drug use; he smokes cigarettes socially.

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Allergy/Intolerance/Adverse Event History

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Sulfa: Rash

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Medication History

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Insulin glargine injects 32 units subcutaneously at bedtime

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Insulin lispro injects insulin according to carbohydrate intake and as needed prior to meals

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Acetaminophen as needed

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Ibuprofen 400 mg PO as needed for aches and pains

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Hydrocodone/acetaminophen 5/500 mg PO as needed (he borrows from a friend occasionally; recently, due to the pain he has borrowed quite a bit)

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