Abstract

This case describes an elderly patient with very acute changes in her chronic ulcer, which started at the same time she experienced volume overload from her CHF, lethargy, and altered mental status. The patient required an emergent session of hemodialysis followed by surgical intervention. Upon resolution of symptoms, the primary medical team and nephrology service recommended that she officially undergo dialysis sessions to address her fluid overload, prompting her discharge to a skilled nursing facility. It was noted that the patient had not been taking her diuretics for the last month, which could have led to the clinical event. Due to increased preload in the setting of CHF exacerbation, one explanation for the ulcer’s progression may involve increased skin tension and serosanguinous fluid that could have led to further progression of the ulcer.