58F CKD(? Diabetic Nephropathy ) ; HTN /DM/Hypothyroid Since 8years

A 58F who is a resident of Varketpally (Near Choutuppal),Who was a Daily wage agricultural Labourer by occupation came to our casualty with complaints of :

Ulcer over Lt. Foot Since 1month
Fever Since 1 week  
Decreased Urine Output Since 3 days
SOB since 1 day
Altered Sensorium Since 1 day 

Patient Was apparently asymptomatic 8 years back then she had Fever With Generalized Weakness for which she went to a Local Practitioner where she was diagnosed to have HTN ; DM ; Hypothyroidism for which she was started on Tablets ( Recent Medication : TAB.GLIMEPIRIDE 1mg + METFORMIN 500mg +VOGLIBOSE 0.2mg ; TAB.ATENOLOL 50mg + AMLODIPINE 5mg ; TAB.HYRONORM 25mcg ). Since then she stopped going to work & Looking after household work. Most of the time she used to develop severe weakness for which she used to go to that Local Practitioner where she used to take INSULIN in v/o Raised Sugars. ( H/O of Such Multiple Episodes). 

March 2024 : 
While Walking around near home with barefoot she had injury to her left leg with a small stone then she developed a small wound over left foot for which she got regular dressing done at local practitioner but it did not heal completely. 

April 2024 : 
The wound was gradually increased in size ; Then she developed Fever which is high grade. Decreased Urine output 3 days Back associated with SOB & altered sensorium Since 1 day.

Past History : 
K/C/O HTN ; DM ; Hypothyroidism Since 8 years

Personal History: 
She was a agricultural labourer by occupation who used to go to work from 9AM to 7PM which involves working in Paddy Feilds & Cotton Fields. She used to have Rice 3 times a day.Earns 400-500 INR /day. But after diagnosed to have DM she stopped going to work & Looking after household work. She changed her diet habits including Java & Gatka Morning & Night ; Rice in the Afternoon.

Her Husband works as Watchman & They have 2 children. Daughter got Married 12 years ago & Son got Married 10 years ago. But Son & Daughter in Law got Seperated From them 8 years ago. Currently her Son stays in Dubai & Daughter in law stays in the same village but Seperately.

Vitals at the Time of admission : 

Bp:150/80mmHg
Pr:82 bpm
Rr:26cpm
Temp 97.8
Spo2: 97 on 2 lit
Grbs 118 mg/dl

Clinical Images : 



Ulcer Images : 

19/04/24 :


 Investigations : 




Diagnosis: 

Altered Sensorium Secondary to ? Uremic Encephalopathy ( Resolved ) 
CKD on MHD
Non Healing Ulcer of Lt.Foot
K/C/O HTN/DM/Hypothyroidism since 8 years

Patient Sensorium Improved gradually & Spontaneous Opening was Present on 25/4/24. Then she gradually started talking & Recognizing her advocates by 27/04/24.








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