Botulinum Toxin Injections for Treatment of Diabetic Ga...

Botulinum Toxin Injections for Treatment of Diabetic Gastroparesis

A 75 year-old African American female with diabetic gastroparesis is admitted to the hospital with generalized weakness, N/V and hematemesis for 2 days.
PMH:
DM2, ESRD on CAPD, HTN, Depression, Diabetic gastroparesis, Diabetic ulcer of LLE
Medications:
Norvasc, Metoprolol, Lisinopril, ASA, Paxil, Lyrica, Neurontin, Clonidine, Colace, Percocet, NPH, SSI
Physical examination:
Obese in NAD, VSS
Chest: CTA (B)
CVS: Clear S1S2
Abdomen: Distended, decreased BS, NT
Extremities: LLE diabetic ulcer, no pitting edema
Laboratory results:
Anemia of chronic disease, Hgb 10.5 (at baseline)
What would you do?
Monitor H/H and VS
EGD
What is the most likely diagnosis?
Diabetic gastroparesis
Gastritis
PUD

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11/11/2006
Author: V. Dimov, M.D., Department of General Internal Medicine, Cleveland Clinic