Management of a Patient in Septic Shock with Necrotizing Fasciitis and Diabetic Ketoacidosis
Abstract
Each year over 1.7 million adults in the United States develop sepsis with 350,000 of those patients dying or being discharged to hospice. Sepsis is broken into four tiers: systemic inflammatory response syndrome, sepsis, severe sepsis, or septic shock. These tiers define the severity of the patient’s condition. This case report details a patient presenting to the emergency department in septic shock and discusses the management of his condition. A 58 year-old white male presented with altered mental status, bradycardia, hypotension, and leg wounds. On presentation, he appeared gravely ill and his last known well was 2 days prior. On physical exam the patient was cold, bradycardic at 52 bpm, and hypotensive at 100/58 mmHg. Examination of the legs showed wounds on both feet with gangrenous necrosis and visible bugs crawling from old bandages. Lab results showed significant values of blood glucose of 841mg/dL, creatinine of 2.62, WBC count of 15.6K/uL, and lactate of 2.5mmol/L. The patient received 2L of normal saline in-route and an additional 1L on arrival. Broad-spectrum antibiotics were started with vancomycin, cefepime, and clindamycin. Norepinephrine was begun at 6mcg/min, and insulin started for elevated blood glucose. CT scan showed subcutaneous gas in the left lower extremity, general surgery was consulted for necrotizing fasciitis and performed above knee amputation. Post-operative complications included: blood cultures growing group B streptococcus, severe hypernatremia, and acute kidney injury. The patient was successfully discharged to rehabilitation facility after 2 months. This case focuses on the importance of rapid recognition of sepsis and adherence to the Surviving Sepsis Campaign guidelines. Future education should be dedicated to improving public knowledge of the warning signs of sepsis to increase early recognition. Treatment of this patient required a multi-disciplinary team and would not have been successful if not for well-trained providers with up-to-date knowledge of guidelines.
Start Time
16-4-2025 9:00 AM
End Time
16-4-2025 11:30 AM
Presentation Type
Poster
Presentation Category
Health
Student Type
Clinical Doctoral Student (e.g., medical student, pharmacy student)
Faculty Mentor
Brock Blankenship
Faculty Department
Medical Education
Management of a Patient in Septic Shock with Necrotizing Fasciitis and Diabetic Ketoacidosis
Each year over 1.7 million adults in the United States develop sepsis with 350,000 of those patients dying or being discharged to hospice. Sepsis is broken into four tiers: systemic inflammatory response syndrome, sepsis, severe sepsis, or septic shock. These tiers define the severity of the patient’s condition. This case report details a patient presenting to the emergency department in septic shock and discusses the management of his condition. A 58 year-old white male presented with altered mental status, bradycardia, hypotension, and leg wounds. On presentation, he appeared gravely ill and his last known well was 2 days prior. On physical exam the patient was cold, bradycardic at 52 bpm, and hypotensive at 100/58 mmHg. Examination of the legs showed wounds on both feet with gangrenous necrosis and visible bugs crawling from old bandages. Lab results showed significant values of blood glucose of 841mg/dL, creatinine of 2.62, WBC count of 15.6K/uL, and lactate of 2.5mmol/L. The patient received 2L of normal saline in-route and an additional 1L on arrival. Broad-spectrum antibiotics were started with vancomycin, cefepime, and clindamycin. Norepinephrine was begun at 6mcg/min, and insulin started for elevated blood glucose. CT scan showed subcutaneous gas in the left lower extremity, general surgery was consulted for necrotizing fasciitis and performed above knee amputation. Post-operative complications included: blood cultures growing group B streptococcus, severe hypernatremia, and acute kidney injury. The patient was successfully discharged to rehabilitation facility after 2 months. This case focuses on the importance of rapid recognition of sepsis and adherence to the Surviving Sepsis Campaign guidelines. Future education should be dedicated to improving public knowledge of the warning signs of sepsis to increase early recognition. Treatment of this patient required a multi-disciplinary team and would not have been successful if not for well-trained providers with up-to-date knowledge of guidelines.