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Abstract: The patient came to the hospital yesterday with sudden onset of fever and temperature up to 40.1℃ with chills and worsening pain in the right upper abdomen due to left ankle bone fracture without exercise and rising blood sugar 1 month ago and vague pain in the right upper abdomen 1 week ago without concern. After active treatment, the patient was discharged after the clinical symptoms were relieved, the abscess basically disappeared on repeat ultrasound, and the blood routine was normal.
Basic information】Female, 54 years old
Disease Type】Bacterial infection
Hospital】The 988th Hospital of the People’s Liberation Army Joint Security Force
Time of consultation】April 2021
Treatment plan】Intravenous infusion treatment (0.9% sodium chloride injection, vitamin B6 injection, potassium chloride injection, compound amino acid injection (18AA), ceftazidime for injection, meropenem for injection) + oral drug treatment (metformin hydrochloride extended-release tablets) + subcutaneous injection drug treatment (insulin injection)
[Treatment period] 1 month of hospitalization, 6 months of follow-up
Treatment effect] The patient’s temperature was normal, abdominal pain was relieved, the abscess basically disappeared on the ultrasound, and the blood routine was normal.
I. Initial consultation
Patient Wang, 54 years old, with high fever, chills and abdominal pain at the time of consultation, had a history of diabetes mellitus, and usually regulated her blood glucose through exercise, diet control and oral metformin hydrochloride extended-release tablets, with fasting blood glucose fluctuating from 8-10 mmol/L, without obvious discomfort or diabetic complications. Although the medication was not stopped, the blood glucose still fluctuated around 13 mmol/L and remained high.
One week ago, the patient had vague pain in the right upper abdomen and did not pay attention to it. Yesterday, he suddenly developed fever with a temperature as high as 40.1℃, accompanied by chills and increased pain in the right upper abdomen. A 7cm×8cm mixed solid echogenicity was seen and a liver abscess was considered. The routine blood test showed that the leukocytes were 22×10^9/L, neutrophil ratio was 91%, calcitoninogen was 12.9ng/ml (normal <0.5ng/ml), and random blood glucose was 22mmol/L. The preliminary diagnosis was bacterial liver abscess.
II. Treatment history
After the patient was admitted to the department, bacterial liver abscess was considered based on the medical history, symptoms, signs and auxiliary examinations, and because there was a small amount of liquefied shadow in the mass, she immediately went to the ultrasound room for abscess placement and drainage, and about 15 ml of yellow pus was withdrawn, mixed with a small amount of blood, and the pus smear indicated Gram-negative bacteria. and sepsis.
After discussion in the department, the descending step anti-infection treatment plan was immediately initiated, and a highly effective, broad-spectrum, low-resistant carbapenem antibacterial drug, meropenem for injection, was selected for intravenous input, while blood glucose was regulated and subcutaneous insulin injection was added to stabilize blood glucose at 7-9 mmol/L. It was not possible to rush to lower it to the normal range for a short time to prevent hypoglycemic reaction, chills, hyperthermia and hyperglycemia.
Since sepsis causes serious depletion state to the organism, the patient is given enhanced nutritional support treatment, 0.9% sodium chloride injection, vitamin B6 injection, potassium chloride injection, compound amino acid injection (18AA), ceftazidime for injection and other intravenous input, regular replacement of drainage bag, and dynamic monitoring of abscess size and pus outflow. 1 week later, the pus culture indicates Klebsiella pneumoniae After 1 week, the pus culture was positive for Klebsiella pneumoniae subspecies, and ceftazidime for injection was given as step-down anti-infection treatment according to the drug sensitivity results.
III. Treatment effect
After nearly 1 month of treatment, the patient’s body temperature returned to normal, the abdominal pain and discomfort were relieved, the abscess was gradually reduced by dynamic monitoring, and maintained until 3 days without pus flowing out from the drainage tube. The patient was discharged from the hospital after the blood count and calcitoninogen were rechecked and the patient’s blood glucose fluctuated from 6-7 mmol/L.
IV. Notes
We are glad that after a series of active treatment, the patient’s body temperature was normal, the abdominal pain was relieved, the abscess basically disappeared on the rechecking ultrasound, the blood routine was normal, and the patient was discharged from the hospital after comprehensive treatment for liver abscess. However, diabetes is a chronic disease that cannot be completely cured, and if the blood sugar is not well controlled, it may still cause secondary infection and other complications.
1, pay attention to rest, appropriate exercise, maintain a good state of mind, avoid staying up late, overwork, cold and secondary infections.
2, adjust the diet structure, control sweets, pasta and food containing too much fat, and eat more high-quality protein, such as fish, eggs, milk, lean meat, etc., as well as fresh vegetables and fruits containing less sugar.
3. closely monitor the change of blood sugar, it is recommended to maintain it at 6-7mmol/L for a short period of time, oral metformin hydrochloride extended release tablets combined with subcutaneous insulin injection.
4. Review the routine blood test, calcitoninogen and liver ultrasound after one month to assess whether there is any change in the residual pus cavity.
V. Personal insight
With the improvement of living standard, the occurrence of diabetic patients is gradually becoming younger and more complicated. The acute and chronic complications caused by diabetes, such as diabetic ketoacidosis, hyperosmolar coma, secondary infection, heart, brain, kidney, eye and skin damage, etc., make patients suffer from diabetic complications, but often there are no obvious symptoms of discomfort before the complications occur. Many people think that they can eat and drink without any discomfort, and they do not take the doctor’s careful guidance seriously. Unbeknownst to them, there are many complications that can occur with poorly controlled diabetes and are irreversible, and when they occur, they can seriously affect the patient’s quality of life and add a lot of physical pain and financial burden. As in the case of this patient, if treatment is delayed, it is likely to progress to septic shock and subsequently cause multiple organ damage. Therefore, we hereby call on diabetic patients to make sure to closely monitor blood glucose changes, eat healthily, strengthen exercise, keep blood glucose stable and avoid diabetic complications.