Dr. Anudeep Puvvula (Endocrinology) needs a second opinion on this medical case.
An 65 year old gentleman presented with blackish discolration of great toe and nail since 15days
A/w Foul smelly pus discharge, non healing ulcer which is painless and surroundings edema.
Non healing ulcer surround by callus on bilateral medial aspect of heel region. With Bilateral cellulitis.
By occupation he is a bus conductor
H/O Type 2 DM since 15 Year’s HTN since 10 year and DPN since 12 Year’s
After detailed examination his
Sugars are uncontrolled
Acute kidney injury
ABI is normal 1.0
TBI I couldn’t examine in this patient
VPT reviled he has severe neuropathy in both legs
But no deformity as such (no Neuroarthropathy)
Ecg is normal
So I diagnosed this case as
Infective Gangrene of right Hallux
Neuropathy ulcer over bilateral medial ascpect of heel region
Callus over left plantar aspect of fore foot
Cefperazone+ Saulbactum inj intravenous started
Statin, Aspirin and clopidogrel tablets started
ACE inhibitors also started
For sugar control premix insulin twice and
OHA triple combination started.....
Doctors please kindly suggest of anything else I need to change