When There Are Acute Changes In Mental Status In Patients With Diabetes

Start Page: 16
Adam Lang, BS, and Kathleen Satterfield, DPM, FACFAOM

   By the time attendings questioned the residents and medical students about the potential etiology, they had determined the two most likely diagnoses: diabetic ketoacidosis or an infection-related etiology. A bedside check of the patient’s blood sugar, although extremely high at 650, was not definitive for ketoacidosis because it would often be elevated in the presence of an infection.

   The residents performed a physical examination, which did not reveal a neurologic deficit, and the lower extremity exam did not indicate an extensive foot infection. The wound did not probe deeply. There was no cellulitis and only slight exudates.

   The patient received a referral for an internal medicine consultation. Physicians ordered labs for the internist to review.

   When the internist reviewed the chart and examined the patient, he joined the podiatry team on rounds. He complimented the residents on their complete workup. He noted that he did not have to order any additional testing and that the residents had diagnosed the problem correctly on their own. The internist confirmed the diagnosis of diabetic ketoacidosis, which was brought on by the patient’s non-adherence with his insulin regimen and further exacerbated by his infection.

    “At this rate, podiatry is going to put me out of business,” the internist added.

Mr. Lang is a third-year student in the Class of 2011 at the College of Podiatric Medicine and Surgery at Des Moines University.

Dr. Satterfield is a Clinical Adjunct Professor at the Western University College of Podiatric Medicine. She is a Fellow and President-Elect of the American College of Foot and Ankle Orthopedics and Medicine.

Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons.


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