3. Case of non-healing wound, uncontrolled diabetes, and disorientationChief Complaint: An 80-year-old woman was admitted to a hospital in Brazil due to lack of response to medical treatment. She presented with very deep, perforating ulcers.
Because the patient was disoriented, the medical history was provided by her daughter. At the time of evaluation, the patient had abdominal distension. She had a long-standing history of diabetes mellitus, and the toes of one foot were necrotic, with an indication for leg amputation.
Laboratory Investigations: urea 236 mg/dL, creatinine 4.6 mg/dL, AST 17 U/L, ALT 10 U/L. The urine was orange in color with a high bacterial count. Complete blood count revealed leukocytosis (15,700/mm³) with neutrophil predominance and thrombocytosis (platelets 623,000/mm³).
An abdominal CT scan performed 3 years ago, demonstrated cholelithiasis and extensive atheromatosis involving the aorta and the superior mesenteric, iliac, renal, and splenic arteries. There was significant distension of the stomach and small bowel loops, with an area of luminal narrowing in the ileal loops located in the right iliac fossa. Blurring of the pericolonic fat planes and surrounding small bowel loops was noted at the level of the upper right abdominal quadrant. Marked rectal distension was also observed, ending in a blind pouch due to prior surgical manipulation, consistent with sigmoid colon resection and colostomy in the left iliac fossa. A contrast-enhanced study was recommended.
AnalysisKnerr’s RepertoryGeneral; Ulcers, Perforating: Kali-c, Merc-c
Phatak’s Materia Medica
Mercurius Cor. is a powerful disinfectant and has much greater rapidity of action, causing violent effects
Skin; Cold ulcers; perforating, spreading; serpiginous
Rx:
Mercurius corrosivus 30C B. D. for 7 days followed by
Insulinum 6C B. D. for 15 days
Follow-up: The skin started healing slowly, the ulcers started healing and blood sugar gradually improved.
Comment:
Mercurius corrosivus helped, but the healing was very slow. Hence, we started her on
Insulinum in 6C potency.
If there are no symptoms, I generally prescribe
Insulinum 6C, for two to three weeks.
When symptoms are present such as marked weakness, excessive hunger, craving junk food, obesity, disrupted circadian rhythm, high stress, or an urge to overwork, I use
Insulinum 30C. In these cases, I prescribe four pills once daily for approximately 25 days to one month.