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No abstract available. Article truncated at 150 words. History of Present Illness: The patient is 54-year-old man with type 1 diabetes mellitus admitted for diabetic ketoacidosis (DKA). He complained of somnolence, nausea and vomiting and right foot pain. He had been admitted 2 weeks earlier for right foot gangrene. He had been receiving daptomycin for his right foot gangrene. PMH, SH and FH: He had a previous history of osteomyelitis, perianal abscess, maxillary abscess, Candida esophagitis, transient ischemic attack, and peripheral vascular disease. He had previous amputations along with thrombectomy/ embolectomy/bypass. He was a former Marine and construction worker with ongoing cigarette use. Family history was noncontributory. Physical Examination: Febrile to 38.2ºC, Crackles bilaterally, Transmetatarsal stump with dry gangrene. Radiography: An admission chest x-ray was performed (Figure 1). Which of the following are appropriate at this time? 1. Blood and wound cultures; 2. Empiric antibiotics including coverage for Staphylococcus aureus; 3. Intravenous insulin and fluids; 4. Serially monitor ... |
