Case Study: Infections in Diabetes Mellitus

Schaberg, Dennis S.; Norwood, John

doi:10.2337/diaspect.15.1.37

Cited by 9 publications

(5 citation statements)

References 59 publications

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“…Microvascular angiopathy has been described as a likely cause of limb sepsis in such patients. 37 First presentation of diabetes mellitus as DKA is well documented and this occurred in 27 patients (25.71%) which is consistent with the literature. 6 , 11 In some instances, no identifiable trigger could be found and this has also been well described.…”

Section: Discussionsupporting

confidence: 88%

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Ndebele

Naidoo

2018

Afr. j. prim. health care fam. med.

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BackgroundDiabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal.MethodsA retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients’ demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.ResultsOne hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.ConclusionThe prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM.

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Section: Discussionsupporting

confidence: 88%

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Ndebele

Naidoo

2018

Afr. j. prim. health care fam. med.

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“…As per a prospective analytical study conducted by AlGoblan et al, 25 early resolution of the foot ulcers occurred in 61% patients who were a normal weight, compared to 49% obese patients whose condition took more than double the time to resolve. 26 …”

Section: Pathophysiological Factors In Dry Gangrenementioning

confidence: 99%

Autoamputation of diabetic toe with dry gangrene: a myth or a fact?

Wahbi¹

2018

DMSO

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Diabetes is associated with various complications and reduced quality of life. Of the many complications, some are life-threatening. Among these, foot complications remain an important concern. The major foot complications include foot ulceration, cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis, with different pathophysiological concepts behind each of them. Gangrene occurs due to reduced blood supply in the body tissues that leads to necrosis. This condition may arise because of an injury, infection, or other health conditions, majorly diabetes. Gangrene is classified as dry, wet, and gas gangrene. In case of wet and gas gangrene, surgical amputation is usually performed to prevent the spread of infection to other tissues. In dry gangrene, due to the presence of clear demarcation, autoamputation is preferred in certain parts of the globe. The present review aims to analyze the mode of dry gangrene management in diabetic patients based on previous evidence and plans to highlight various management strategies available for dry gangrene and the advantages/disadvantages of different treatments with special consideration to autoamputation.

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“…27,28 Hyperglycemia also increases the risk of developing EC because of its direct correlation to microvascular angiopathy, which is predictive of soft tissue and organ infections in diabetic patients. 29 Diabetic arteriopathy leads to distal tissue and organ parenchymal ischemia, thus increasing the possibility of bacterial proliferation. 3…”

Section: Clinical Findingsmentioning

confidence: 99%

Emphysematous Cholecystitis

Safwan

Penny

2016

Journal of Diagnostic Medical Sonography

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Emphysematous cholecystitis (EC) is a rare but deadly variant of acute cholecystitis noted by the presence of gas in the gallbladder lumen or wall. This gas, emitted by bacteria, is thought to result from gallbladder ischemia caused by vascular compromise with subsequent bacterial invasion. The two most common bacteria responsible for EC are Clostridia perfringens and Escherichia coli. Symptoms of EC are similar, although often less overt, compared to those of acute cholecystitis (AC). Sonography and radiography are common methods of diagnosing EC, but computed tomography (CT) carries the highest diagnostic accuracy rate. Laparoscopic cholecystectomy is the most common method of treating EC, although conservative therapy and hyperbaric oxygen therapy have also been effective in some cases.

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Case Study: Infections in Diabetes Mellitus

Cited by 9 publications

References 59 publications

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Autoamputation of diabetic toe with dry gangrene: a myth or a fact?

Emphysematous Cholecystitis

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