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Cellulitis pedis dextra in type 2 diabetes mellitus with obesity 1: A case report
Journal Abstracts Result: During hospitalization patient well tolerates nutrition therapy. Patient was able to mobilize on POD 6, and discharged on the following day. Conclusion: Adequate nutrition support during hospitalization had contributed to her improvement on clinical outcome and functional capacity. Keywords: Hemorrhagic pancreatitis; Nutrition therapy http://dx.doi.org/10.1016/j.orcp.2013.08.104 T5:P.070 Cellulitis pedis dextra in type 2 diabetes mellitus with obesity 1: A case report E. Kurniawati ∗ , S. Sukmaniah Department of Nutrition, Faculty of Medicine, University of Indonesia, Indonesia Introduction: Diabetic patients have high risk of foot infection such as cellulitis. Wound healing is affected by obesity, which is important modifiable risk factor for type 2 diabetes mellitus. Patients’ management of this case has to be implemented individually by a multidisciplinary team. Our purpose is to improve skills and knowledge in nutrition management of cellulitis in type 2 diabetes mellitus with obese I. Case description: A-43-year old woman came with a diagnosis of cellulitis at right foot, uncontrolled type 2 diabetes mellitus, and obesity I (BMI 29.8 kg/m2 ). She complained swelling and erythema at her right leg, fever, headache, nausea, vomits, and loss of appetite. Physical examination findings were cellulitis, edema at right leg, and abcess at right foot. Laboratory findings were leukositosis (20000 cell/uL), ESR 91 mm/h, hypoalbuminemia (3.2 mg/dL), hyponatremia (131 mmol/L), blood sugar 360 mg/dL, HbA1C 10%. Food intake analysis were protein 11%, fat 45%, carbohydrate 43%, and fiber intake 6 g. Proper control of blood glucose with insulin and adequate nutritional support, infection control by antibiotic medication and debridement, and also education were given to this patient. Result: During 3 weeks of hospitalization, clinically improvement was seen. During the first ten days blood glucose just seems still high although nutritional support and insulin therapy were given. After discharge, patient went to diabetes mellitus clinic regulary and showed improvement in healthy eating habit. Conclusion: Successful management therapy in the patient was achieved by involvement a multi-
43 disciplinary team, nutrition support, family support and patient’s motivation. http://dx.doi.org/10.1016/j.orcp.2013.08.105 T5:P.071 Severe sepsis post thoracotomy and gastric tube removal in thorax empyema Ec leakage gastric tube post gastric pull-up with obesity II: A case report E.M. Christine ∗ , S. Sukmaniah Department of Nutrition, University of Indonesia, Indonesia Introduction: In patient with obese, there were many physiologic changes that may impair the ability to adapt to the stress of critical illness and may influence intensive care unit (ICU) survival. Case description: A 49 years old male was hospitalised in ICU-RSCM with severe sepsis post thoracotomy and gastric tube removal in thorax empyema Ec gastric tube leakage post gastric pullup, obesity II. Patient’s chief complaints were recurrent leakage of gastric tube and uncontrolled infection since a month ago. Patient was undergone three kinds of surgeries, because of recurrent leakage of gastric tube. Patient was on ventilation with hemodynamic parameter were stable under drug’s influence. Laboratory finding revealed anemia, leucocytosis, hypoalbuminemia, increasing procalsitonin level, hyponatremia, hypocalcaemia, and hypomagnesaemia. Patient received several drugs and vitamin from the intensivist. The energy requirement was calculated based on the Ireton—Jones formula for ventilated patients, i.e. 21 kcal/kg of actual weight via gastrotomy and parenteral. Results: The patient’s hemodynamic parameters always depend on drugs, and could not wean from ventilation. The patient could tolerate the nutrition given to him, but always having diarrhea and recurrent leakage of gastric tube. Even though temporary having a better condition, he was worsening because of uncontrolled sepsis. Patient was finally died. Conclusion: The nutritional management in obese patient is quite challenging. The mortality of the patient was suspected because of uncontrolled sepsis and functional lung impairment, which the obesity condition contributed to the poor outcome of the patient.
43 disciplinary team, nutrition support, family support and patient’s motivation. http://dx.doi.org/10.1016/j.orcp.2013.08.105 T5:P.071 Severe sepsis post thoracotomy and gastric tube removal in thorax empyema Ec leakage gastric tube post gastric pull-up with obesity II: A case report E.M. Christine ∗ , S. Sukmaniah Department of Nutrition, University of Indonesia, Indonesia Introduction: In patient with obese, there were many physiologic changes that may impair the ability to adapt to the stress of critical illness and may influence intensive care unit (ICU) survival. Case description: A 49 years old male was hospitalised in ICU-RSCM with severe sepsis post thoracotomy and gastric tube removal in thorax empyema Ec gastric tube leakage post gastric pullup, obesity II. Patient’s chief complaints were recurrent leakage of gastric tube and uncontrolled infection since a month ago. Patient was undergone three kinds of surgeries, because of recurrent leakage of gastric tube. Patient was on ventilation with hemodynamic parameter were stable under drug’s influence. Laboratory finding revealed anemia, leucocytosis, hypoalbuminemia, increasing procalsitonin level, hyponatremia, hypocalcaemia, and hypomagnesaemia. Patient received several drugs and vitamin from the intensivist. The energy requirement was calculated based on the Ireton—Jones formula for ventilated patients, i.e. 21 kcal/kg of actual weight via gastrotomy and parenteral. Results: The patient’s hemodynamic parameters always depend on drugs, and could not wean from ventilation. The patient could tolerate the nutrition given to him, but always having diarrhea and recurrent leakage of gastric tube. Even though temporary having a better condition, he was worsening because of uncontrolled sepsis. Patient was finally died. Conclusion: The nutritional management in obese patient is quite challenging. The mortality of the patient was suspected because of uncontrolled sepsis and functional lung impairment, which the obesity condition contributed to the poor outcome of the patient.