diabetic foot ulcer with CKD

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.


This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

D. Shreeya , 8th sem ,roll no 39



 A 49yr old male contracter by occupation r/o nalgonda came to OPD with chief complaint of swelling in the right leg since 20days and fever since 1 week.

History of presenting illness 
Patient was apparently asymptomatic 20days back then he developed pain in the right lower limb and for which he went to Near by hospital  and treated with antibiotics and then   he developed swelling in the lower limb  which is insidious in onset ,gradually progressive ,pitting type initially at ankle ,extended till knee  then he developed a bubble like thing in the dorsum of the right foot which bursted and developed into an ulcer
 H/o fever since 1week which is intermittent associated with chills and rigors.
No h/o burning micturition ,and decreased urine output
Patient developed  shortness of breath 2yrs back and came to our hospital and diagnosed with heart disease (CAD)and renal disease and he was referred to Hyderabad kims and was treated and symptoms subsided
Daily routine 
He wakes up in the morning 5'o clock goes to narketpalli  and come back by 7am and have lunch and then go back to nky for site visit and come back by 5pm then at night he will have the dinner and go to sleep by 11pm
Past History 
Diabetes since 12 yrs and using glimepiride 
Hypertenstion since 12yrs for which he is using nifidipine
No History of asthma, Epilepsy, Tuberculosis 
Had a History of dialysis
 1st on 22/7/22
2nd on 24/7/22
3rd time on 21/7/22
4th time on  on 29/7/22
Personal History 
Diet-mixed
Appatite-normal
Sleep-adequate 
Decreased urine output(3 to 4 times a day)
Normal Bowel movements 
No addictions 
No allergies 

Family History 
No significant 
Treatment history 
He is using ecosprin,furasamide,folic acid,bisprostol since 2 yrs
And glicazide since 12yrs for diabetes daily morning 
General examination 
The patient was consious, coherrent, cooperative  Well oriented with time, place and person .well built and nourished 
No pallor 
No icterus 

No cyanosis
Pedal edema
Edema of left hand
no lymphadenopathy 
Vitals
temp-afebrile(98.6)
Bp-120/90mm of Hg 
PR-88bpm
RR-18cpm
Spo2-97%
GRBS-107mg/dl
Systamic examination 
Clinical pictures 
Investigations 
HIV-non reactive
Serum iron-87ug/dl
Anti HCVantibodies -NON REACTIVE
RBS-80mg/dl
Blood group-o(-ve)
HBsAg-negative
CBP
RFT
LFT
USG
ECG
chest x ray
PND-ulcer with CKD
TREATMENT:
Fluid and salt restriction
Tab.NICARDIA XL 30 mg /od
Tab.Bisoprolol 5mg /od
Tab.ecospirn 75/20mg
Tab.lasix 40mg
Tab.Nodosis 500mg/BD
Tab. Orofer xt /po/OD
T.BACT Ointment 
Regular dressing compressive crepe bandage.


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