Type of publication:
Conference abstract
Author(s):
*Cane C.L.; *Beard N.; *Breeze S.; *Moulik P.K.
Citation:
Diabetic Medicine. Conference: Diabetes UK Professional Conference 2024. London . 41(Supplement 1) (no pagination), 2024. Date of Publication: 01 Apr 2024.
Abstract:
A 49-year-old schoolteacher with insulin treated type 2 diabetes attended the diabetic foot clinic. Four days prior he tripped causing a left big toe superficial abrasion. He felt unwell the next day with chills. In MDT clinic, he had normal blood pressure and glucose, temperature 37.2degreeC, left hallux superficial ulcer, SINBAD score 3, cellulitis on left forefoot, neuropathy, biphasic foot pulses on doppler. The hospital was in critical incident, the patient was compliant but reluctant to come in and a decision for supervised outpatient treatment made with daily phone contact, alternate day attendance with safety netting advice to attend A&E. He was started on CGM (Freestyle Libre), oral co-amoxiclav and ciprofloxacin. Initial abnormal blood tests (WBC 18.7 x 109/L, CRP 210 mg/L, Lactate 2.4 mmol/L, Glucose 10.8 mmol/L) results improved on retesting. Sepsis symptoms were settling. After 4 days, foot doppler signals became monophasic and with tissue necrosis on the hallux though his cellulitis was settling. He was admitted briefly for intravenous antibiotics and urgent MRI angiogram (showed good anterior tibial inflow into foot). The foot is slowly healing, his foot pulse doppler signal has returned to biphasic, but there is an eschar on the left hallux and the toenail has fallen off. The case highlights the risk of capillaritis in diabetic foot sepsis which can lead to rapid tissue hypoperfusion and necrosis. Doppler signals are unreliable in presence of sepsis and tissue oedema. A virtual ward setup with intravenous antibiotics and rapid diagnostic test access is being developed before the winter bed crisis.
DOI: 10.1111/dme.15296
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