Diabetic foot is one of the most significant and devastating complications of diabetes and is defined as a foot affected by ulceration that is associated with nephropathy and peripheral arterial disease of the lower limb in a patient with diabetes.

1. Makbul Hussain Chowdhury
DOCTOR OF PHARMACY
4th YEAR
15Z11T0006
CASE STUDY ON DIABETES
INDUCED FOOT ULCERS

2. INTRODUCTION
 Type 2 DM is a non insulin dependent DM
 75% OF People suffer with type 2 DM.
 Complications of type-2 diabetes mellitus.
 A) Diabetic nephropathy
 B)Diabetic retinopathy
 C)Diabetic neuropathy
 DEFINITION OF TYPE 2 DM
 NON INSULIN dependent DM /adult onset of DM
 High blood glucose excess insulin production or
lack of insulin.Now the patient was suffering from
diabetic nephropathy

3. Diabetic foot
DEFINITION:
Diabetic foot is one of the most significant and
devastating complications of diabetes and is
defined as a foot affected by ulceration that is
associated with nephropathy and peripheral
arterial disease of the lower limb in a patient with
diabetes.
 SYMPTOMS:
 Sores, ulcers,blisters on the foot over lower leg.
 Pain, difficulty in walikng.
 Discolouration in feet :black ,blue or red.
 Fever ,skin redness, swelling or other signs of

4. Foot ulcer

5. SUBJECTIVE
NAME:XXXX
AGE:39
SEX:FEMALE
IP NO:17071065
DOA:10.11.18
DEPT:FMW-1

6. CHIEF COMPLAINTS:
Patient brought for casuality with c/o B/L swelling of
feet since 10 days and c/o burning feet&tingling since
2 years
HISTORY PRESENT ILLNESS:
Patient was presented with swelling of both the feet
extending upto ankle which decrease in size when
the patient is at supine position. swelling is gradually
progressive not associated with pain at both feet 2
years co burning feet and tingling .
HISTORY OF PAST ILLNESS:
Past H/O admission in hospital due to non-healing
ulcers . H/O blood transfusion 2 years back, 10
packed RBC.

7. OBJECTIVE
 PHYSICAL EXAMINATION:
Temp:98.4C
PR:76/min
Respiration rate:16/min
odema of feet:yes
 SYSTEMIC EXAMINATION:
Cvs:S1,S2(+),no added murmers
Rs:lungs-NVBS (+) clear
Abdomen:PA soft, no organomegaly

8. LABORATORY REPORTS
S.NO PARAMETERS OBSERVED
VALUES
NORMAL
VALUES
01 T.RBS Increase
180mgdl
79-140mgdl
02 Blood urea Inease 56mgdl 15-40mgdl
03 Creatinine Increase
1.9mgdl
0.5-1.2mgdl
04 Sodium 135mmol/L 135-155mmol/L
05 Potassium 4.2 mmolL 3.5-5.5 mmolL
06 T.WBC Count Increase
11,500cumm
4000-
11000cumm
07 Neutrophills 55% 40-80%
08 Lymphocytes 38% 20-40%
09 Monocytes 04% 02-10%

9. S NO PARAMETERS OBSERVED
VALUES
NORMAL
VALUES
10 Eosinophills 03% 01-06%
11 Haemoglobin 6.8 gm% 13.5-17gm%(m)
12-16gm%(f)
12 ESR 40mmhr 0-22mmhr(m)
0-29mmhr(f)
13 Calcium 8mgdl 8.5-10.2mgdl
14 Serum phosphorous 3.7mgdl 2.5-4.5mgdl
15 Uric acid 8.0mgdl 2.4-6.0mgdl(F)
3.4-7.0mgdl(M)
16 FBS 120mgdl 70-110mgdl
17 PLBS 174mgdl 90-130mgdl

10. ASSESMENT
 DIABETIC FOOT ULCERS

11.  DAY TO DAY PROGRESS:
DAY1: MEDICATIONS:
patient is concious&coherrent. 1.Inj,TAXIM
Temp:Afebrile 2.INJ.LASIX
PR:79/min 3.TAB.LUPINAC
RR:16/min 4.TAB.MEFR XT
BP:130/80mmhg 5.SVP.HAPISIP
CNS:S1,S2(+) 6. CHARTING VITALS
MONITARY
Lungs:NVBS 7.FLUID RESTRICTION
P/A-soft,no organomegally 8.DYTOR

12. DAY2: MEDICATIONS:
Patient is concious&coherrent. 1.INJ.TAXIM
Temp:afedrile 2.INJ.LASIX
PR:80/min 3.TAB.LUPINAC
RR:16/min 4.SYP.HAPISIP
BP:110/80mmhg 5.FLUID.RESTRICTION
CVS-S1,S2(+) 6.I/O CHARTING VITALS
MONITARING
Lungs:NVBS(+) 7.T.B/O-D3
P/A-both no organomegaly 8.TAB.FEUBUXOSTAT
9.TROTIMEX POWDER IN
1 GLASS&MILK TID
10.1 EGG/DAY
11.IVF LONS

13.  DAY3: MEDICATIONS:
 Patient is conscious and coherrent 1.INJ,TAXIM
 Temp:afebrile 2.INJ.LASIX
 PR-80/min 3.TAB.LOPINAL
 BP-110/80mmHg 4.TAB.BIO-D3
 CVS-S1,S2(+)
5.TAB.FEBVXOSTAT
 Lungs-NVBS(+) 6.1 EGG/DAY
 P/A-soft, no organomegaly . 7.IVF LONS

14.  DAY4: MEDICATIONS:
Patient is conscious&coherrent 2.INJ.TAXIM
Temp- Afebrile 3.PROTIMEX POWDER
CVS_S1,S2(+) 4.TAB.BIO-D3
Lungs-NVBS(+) PR=80 5.TAB.LUPINAC
BP-140/90mmhg 6.IVF LONS
P/A-soft ,no oraganomegaly .7.1 EGG/DAY
8. I/ O CHARTING VITALS
MONITORING 1.TAB.FEDUXOSTAT 9.
INJ.LASIX

15. TREATMENT PLAN
S.
N
O
BRAND
NAME
GENERIC
NAME
INDICATION DOS
E
RO
A
FRE
QUE
NCY
1 INJ.TAXIM CEFOTAXIM
E
BACTERIAL INFECTION
,CEPHALOSPORIN
ANTIBIOTIC
1 mg IV BD
2 INJ.LASIX FUROSEMID
E
FLUID RETENTION
,KIDNEY DISORDERS
SUCH AS NEPHROTIC
SYNDROME
20m
g
IV 12th
hrly
3 T.LUPINAC TAURINE BLOOD PRESSURE 200
mg
PO BD
4 T.MFERX-T FIORICET For bleeding PO OD
5 SYP.HAPISIP PO TID
6 T.DYTOR TORSEMIDE TREAT HIGH BLOOD
PRESSURE
5mg
½
tab
PO OD
7 T.BIO---D3 BESTCAL VIT D
SUPPLEMENT
200
mg
PO OD

16. BRAND
NAME
GENERIC
NAME
INDICATION DOS
E
RO
A
FRE
QUE
NCY
8.SYP.HAPIS
IP
PO TID
T.BIO---D3 BESTCAL VIT D
SUPPLEMENT
200
mg
PO OD
T.FEBUXOST
AT
IT DEC.S
URIC ACID IN
BLOOD
40m
g
PO OD
PROTIMEX
POWDER _
PROTIEN
SUPPLIMENT
S
1gls
in
milk
PO TID
IVF LONS 25ml IV Per
hr
T.MFERX-T FIORICET PO OD

17. PHARMACIST
INTERVENTIONS
 DRUG INTERACTIONS:
 1.CEFOTAXIME<>TORSEMIDE
 Cefotaxime can cause kidney problem risky when
used with Torsemide.
 2.CEFOTAXIME<>FUROSEMIDE
 Cefotaxime like antibiotics can cause.
 3.Therapy problem:indication with out drug.Drug not
prescrribed for anemia.
suggested drug:IRON SUPPLEMENTS
 4.They prescribed Antibiotics , but they didn’t
prescribed PAN .
 5.The pt is Diabetic ,but they did’nt prescribed any
medication for that.

18. PATIENT COUNSELLING
 Avoid walking long distances until ulcers are
cured. Many topical treatments are available like
foot dressings to avoid microorganisms clean the
fluid coming from ulcers.
 Drink more water.
 Avoid salt diet, avoid mental stresses, take good
medications for diabetes as prescribed by the
physician, and take frequent health checkup.
 Use the prescribed medications in time, if missed
dose skip it if long time duration and take next
dose.

19. REFERENCES
 WWW.Medplus.com
 Reference.medscape.com/drug-interaction
checker
 www.meindia.net/doctors/drug-information

20. Thank you…