18: Diabetic Foot Infection

PATIENT PRESENTATION

Chief Complaint

“My foot is red, draining fluid, and it stinks.”

History of Present Illness

EH is a 58-year-old female who presents to the hospital with a wound to the right plantar surface of the foot that is edematous, erythematous, and with foul-smelling drainage. She was seen in the emergency department 6 days ago and received clindamycin 300 mg every 8 hours for 5 days. She reports compliance with the medications, and has been soaking her feet routinely in hot water. Since that time, her wound has only worsened. She denies fever or chills but reports frequent feelings of hopelessness.

Past Medical History

Insulin-dependent type 2 diabetes, dyslipidemia, HTN, ESRD (on dialysis), depression, hypothyroidism, and CAD

Surgical History

AV fistula placement, cholecystectomy, coronary artery bypass graft, finger amputation, oophorectomy, tonsillectomy, and adenoidectomy

Family History

Father had diabetes, Alzheimer’s disease, heart disease, HTN, high cholesterol, arthritis, and vision loss and passed away 2 years ago; mother has diabetes, HTN, high cholesterol, and history of stroke

Social History

Smokes ½ pack per day × 15 years; reports no alcohol or illicit drug use

Allergies

Penicillin (lip swelling, tongue irritation; has tolerated cephalosporins and carbapenems in the past); atorvastatin (“spaghetti legs”; tolerates pravastatin)

Home Medications

Allopurinol 100 mg PO daily

Amlodipine 10 mg PO daily

Aspirin 81 mg PO daily

B-complex-C-folic acid (RENA-VITE): 1 tablet PO daily

Calcitriol 0.25 mcg PO daily

Carvedilol 25 mg PO BID with meals

Cetirizine 10 mg PO daily

Furosemide 20 mg PO daily

Insulin glargine 35 units subcutaneously qHS

Insulin lispro 4 units subcutaneously TID before meals

Levothyroxine 50 mcg PO daily

Omeprazole 20 mg PO daily

Pravastatin 80 mg PO qHS

Sevelamer 3200 mg (4 tablets) PO TID with meals

Sertraline 100 mg PO daily

Physical Examination

Vital Signs

Temp 98.3°F, P 66, RR 18 breaths per minute, BP 161/94 mm Hg, spO₂ 99%, Ht 5′4″, Wt 81.1 kg

General

Well-developed, well-nourished female oriented to person, place, and time

HEENT

Normocephalic, atraumatic, external ears normal, oropharynx clear and moist; no discharge from eyes, no scleral icterus; neck supple

Pulmonary

Effort and breath sounds normal; no ...