CASE PRESENTATION
ON
DIABETIC FOOT
UNDER THE GUIDENCE OF : BY:
SUMMAYA JABEEN
MR MOHD FAREEDULLAH
PHARM.D IV/VI
(ASST. PROFESSOR IN DEPT OF PHARMACY) ROLL NO: 1700716883022
DEFINITION:
It is a vulnerable infection of the feet which can be more severe then it appears
Occurs due to the peripheral nerve damage due uncontrolled blood glucose level.
It is characterized by foot ulcer, infection and neuropathic osteoarthopathy (charcoal feet).
SIGNS AND SYMPTOMS:
• Redness in the area of the feet
• warmth
• Swelling in toes
• Severe pain
PATIENT DEMOGRAPHIC PROFILE
AGE : 41yrs
UNIT : General Surgery
WEIGHT : 78kg
GENDER : Male
IP NO : R118013676
Date of Admission : 10/08/18
Date of discharge: 15/08/18
Consultant name: Dr. Mumtaz Hussain
SUBJECTIVE
▪ A 41 yr old male patient was admitted to general surgery dept with
chief complaints of pain in the left foot due to diabetic foot ulcer, pain
is throbbing in nature , aggravate on walking, relieves at rest.
PAST MEDICAL HISTORY:
History of ulcer 1 month back
DM+ -was on Glycomet 500mg
HTN+ -was on Aten 50mg
PERSONAL HISTORY: NIL
4
LABORATORY EXAMINATION REPORTS
HEMATOLOGY
INVESTIGATION RANGE NORMAL UNITS
RANGE
RBC 4.41 4.5-6.5 cumm
WBC 14000 4000-11000 cumm
HGB 8.7 11.5-17.5 g/dl
PLT 461 150-500 Lacs
HBA1C : 11.5%*
BLOOD GLUCOSE LEVELS
TEST/DAT 10 AUG 11 AUG 12 AUG 13 AUG 14 AUG 15 AUG NORMAL
E VALUES
GRBS 245 230 189 176 184 189 70-160
mg/dl
PROVISIONAL DIAGNOSIS:
DIABETIC FOOT
FINAL DIAGNOSIS:
DIABETIC FOOT ULCER
ASSESSMENT:
• PROBLEM-1 : Infection
• MEDICATION :INJ TAXIM(CEFOTAXIME) 1gm IV BD
• PROBLEM-2 :Ulcer Prophylaxis
• MEDICATION :INJ PAN(PANTOPRAZOLE) 40 mg IV BD
• PROBLEM-3 :Severe Pain
• MEDICATION :INJ TRAMADOL(TRAMADOL HCL) 1amp IV BD
• PROBLEM-4 :Fever
• MEDICATION :TAB DOLO(PARACETAMOL) 650mg PO (only when necessary)
• PROBLEM 5 :Bone infections
• MEDICATION : INJ AUGMENTIN(AMOXICILLIN CLAVULANATE) 1.2gms IV BD
• PROBLEM 6 :High Blood Sugar
• MEDICATION :INJ HAI(HUMAN ACTRAPID INSULIN) Acc to GRBS.
• PROBLEM 7 :Wound Repair, Post surgery pain
• MEDICATION :TAB CHYMORAL FORTE(TRYPSIN) 50mg PO BD
TREATMENT GIVEN
DRUGS DOSE ROA FREQ DA DS GENERIC ADVERSE
NAME EFFECTS
Inj taxim 1gm IV BD 10/8 12/8 cefotaxime Constipation,
headache
Inj pan 40mg IV BD 10/8 15/8 Pantoprazole pain at
injection site,
abdominal pain
Inj tramadol 1 amp IV in 100 BD 10/8 15/8 Tramadol Hcl dizziness
ml NS
Tab dolo 650mg PO Only paracetamol GI disturbance
When
necessary
Inj augmentin 1.2gms IV BD 10/08 15/08 Amoxicillin Diarrhea,nause
clavulanate a vomiting
sensation
Inj HAI According Human
to GRBS Actrapid Insulin
levels
Tab chymoral 50mg PO BD POST- Trypsin Itching ,SOB
Forte OPERATION
DAYS CHIEF BP fever PULSE RESPIRATO ADVICE MEDICATIONDAY
COMPLAINTS RATE RY RATE
DAY 1 Pain in L foot 130\8 101 80 25 bacteriology Continue same
pus discharge 0 treatment
DAY 2 Pain in L foot 120\7 100 82 20 CBP CST
pus discharge 0
DAY 3 No fresh 110\80 100 84 22 CST –INJ TAXIM
complaints
DAY 4 No fresh 130\8 98 85 28 Amputation CST
complaints,af 0
ebrile
DAY 5 No fresh 120/8 98 83 24 Toe CST +
complaints 0 amputated. Inj.Zofer +TAB
CHYMORAL
FORTE
DAY 6 Post 120/8 98 80 23 CST
-operative 0
pain ,Vitals
stable
PLAN
DRUGS DOSE ROA FREQ GENERIC
NAME
T Augmentin 625mg PO BD AMOXICILLIN
CLAVULANAT
E
T pan 40mg PO BD PANTOPRAZ
OL
T tramadol 20mg PO OD TRAMADOL
HCL
Tab Zofer 4mg PO OD ONDANSETR
ON
PHARMACIST INTERVENTION
For decreased level of hemoglobin, no medication was prescribed in
the discharge medication
DRUG DRUG INTERACTIONS:
NO drug interactions were found
PATIENT COUNSELLING:
REGARDING THE DISEASE:
• Diabetic foot is a condition in which, blood glucose, or blood sugar
levels are too high. Over time, this can damage your nerves or blood
vessels. Nerve damage from diabetes can cause you to lose feeling in
your feet. You may not feel a cut, a blister or a sore. Foot injuries such
as these can cause ulcers and infections. Serious cases may even lead
to amputation. Damage to the blood vessels can also mean that your
feet do not get enough blood and oxygen. It is harder for your foot to
heal, if you do get a sore or infection.
REGARDING MEDICATION:
• The patient was explained about the importance of medication
adherence for the effective treatment of the disease.
• Avoid skipping dose when feeling better.
• If the dose is missed take as soon as you remember.
• Donot use extra dose to make up for missed dose.
• Tab Pan 40 should be taken empty stomach.Take it preferably 30 mins before food.
• Tab Zofer-donot chew or crush or break.Take with food or without food.
• Tab augmentin-finish the prescribed course,even if u feel better.Take it with food
and plenty of fluids.
• Tab tramadol-Avoid driving as u may feel dizzy.Take with food.
REGARDING LIFESTYLE MODIFICATION
• Regular medical exams, including foot checks at every visit and checking
your ABCs (A1c, blood pressure, and cholesterol)
• Monitoring your blood sugar daily
• Regular exercise
• Eating a balanced diet rich fruits and vegetables
• Avoid food that increases blood glucose levels.
Thank you
