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    Case study on diabetes and congestive heart failure

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    Case Study Three

    Present Illness

    Mr. Tompkins is a 62-year-old Native American male. He comes in because of increasing dyspnea on minimal exertion (DOE) and swelling in his legs for the past week. He has also noticed that his lower legs are red, warm to the touch, and mildly painful—4 out of 10 on a pain scale. His blood sugars have been high: 190 fasting in the morning and 290 before evening meal. His diet has not changed, although he has been less active the past week due to the swelling in his legs. He denies chest pain, cough, fever, hemoptysis, taking any over-the-counter medications, polyuria, polydipsia, and polyphagia.

    Medical History

    Diabetes mellitus (DM) type II for 5 years
    Family History

    His wife, children, and four living siblings have DM type II. His father and two brothers, now deceased, had hypertension and DM type II; causes of deaths are not known.


    Metformin increased to 1 Gm bid 30 days month ago to bring his sugars down about 20 to 30 points in the morning and evening.


    None reported

    Social History

    Patient does not smoke or drink.

    Physical Examination

    Weight 225 lbs +10 pounds since his last visit 1 month ago, BMI 30

    BP - 158/100, P - 100, T - 98, O2 sats - 94% room air at rest

    S3 & S4 gallop, + JVD, bibasilar crackles, 3+ pitting edema.

    The skin on his ankles to mid-calf is red, warm, slightly scaly, and tender to the touch.


    TSH -5.2 (0.5- 4.5)
    Free T4 - 0.8 (0.8-1.7)
    Free T3 - 1.8 (2.0-4.8)

    A1C - 9 (<5.7)
    Hemoglobin - 12 (13.8 - 17.2)
    Hematocrit - 38 (41 - 50)
    RBC indices are normal
    WBC - 12 (4.5 - 10.5)
    BUN - 22 (7 - 20)
    Creatinine - 0.6 (0.8 - 1.4)
    Total cholesterol - 240
    HDL - 35
    LDL - 180
    Triglycerides - 400


    Results of a recent chest X-ray are pending.

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    Solution Preview

    The patient most likely suffers from
    1. Peripheral edema (result of volume overload ...

    Solution Summary

    We discuss a case study about a patient suffering from diabetes and congestive heart failure, complicated by cellulitis of both legs.