Case 9: 59 year old male with hyperglycemia
Written by: Ihab B Abdalrahman (Tarawa), MBBS, MD, ABIM Assistant Professor of Medicine, University of Khartoum, Sudan Reviewed by: Tarik A Elhadd MD, FRCP, FRCPE, CCST Professor of Medicine & Endocrinology, Khartoum, SudanCase Description:
A 59 year-old obese male, presents to the Emergency Room with fever for 2 days, associated with left leg pain and swelling. He is known to have type 2 Diabetes Mellitus for 11 years on gliclazide 80 mg twice a day and metformin 850 mg twice a day.
Physical Examination revealed an ill-appearing, slightly confused male.
Vitals Signs : T 39.3 degrees centigrade, HR 106/min , BP 104/80, Pulse oximetry 96% on room air.
Examination of the heart, chest and abdomen was unremarkable.
There was no focal neurological deficit.
His left leg was swollen, hot and tender.
There was a 22 X 13cm area of erythema surrounding a 5X5 cm ulcer which had purulent drainage.
Laboratory results:
| Test |
Value |
Normal values |
| WBC count |
18,000 |
3500-10,000 in blacks |
| Hemoglobin (mg/dl) |
11.4 |
14-17 in males
|
| Na (mmol/l) |
142 |
136-145 |
| K (mmol/l) |
4.8 |
3.5-5 |
| Creatinine (mg/dl) |
1.9 |
0.7-1.3 |
| Random blood sugar (mg/dl) |
389 |
- |
| HbA1c |
11.2% 4 weeks ago |
- |
| Urinalysis |
Positive for sugar and protein No ketones |
- |
| Left lower limb Doppler Ultrasound |
Negative for DVT |
- |
He was admitted to the hospital with an infected diabetic ulcer, cellulitis and hyperglycemia and was started on intravenous fluids and intravenous antibiotics. The surgeon has evaluated him and plans to debride the in the operating room the following morning.