godfather of surgery

Chapter 285 The Coin of Life

Lactic acidosis makes the acid-base balance of the human body unbalanced, which in turn causes electrolyte ion disturbance, leading to arrhythmia or cardiac arrest.

A 50% chance of dying is about the same as flipping a coin.

Wei Danian has attacks at least once a year, which means that his life has to be flipped between life and death once a year.For so many years, he actually got the side he wanted every time.

"Perform bedside hemofiltration!"

Dr. An in the ICU made a decisive decision. This is the fastest way to remove excess lactic acid in the blood.At the same time, he will continue to supplement the patients with alkali, and accurately calculate the amount and speed of alkali supplementation.

If the amount of alkali supplementation is too large or the speed is too fast, it will cause new problems and cause new disturbances in electrolyte ions.

The nurse began to puncture the arteries and veins to connect the patient to the vascular circuit of the hemofiltration machine. After the connection was successful, the blood pump was started, the replacement fluid and filtration device were activated, and the blood filtration began.

"Our anticoagulation won't cause massive bleeding at your surgical site?" Dr. An asked for Dr. Jin's opinion.

Dr. Jin is very sure: "No, no problem, we can subcutaneously inject low-molecular-weight heparin calcium anticoagulant immediately after surgery for patients undergoing artificial joint replacement under general anesthesia to prevent deep vein thrombosis."

"That's good!" Dr. An was relieved, cleared lactic acid, replenished alkali to correct acid, replenished liquid to expand volume, and cut it with three tricks. It will be observed if it works.

Yang Ping has been waiting by the side, and several young doctors and interns are asking him some questions. He is very famous in the hospital, and there are many young doctors who don't know him.

As for the good people, they usually only watch from a distance, but now they get along closely. Naturally, the studious doctor has a lot of questions to ask.

The three tricks seemed to be effective. Wei Danian's blood pressure slowly increased, the blood lactic acid value of the blood test reexamination began to decrease, and the blood pH value gradually increased.

"It was discovered in time, and the chance of successful rescue is relatively high." Dr. An saw hope.

"What should I pay attention to in the lower limbs undergoing surgery?" the nurse asked.

"Be careful when moving, and a special person is needed for a little traction. We will come to change the dressing and extubate the negative pressure drainage." Dr. Jin guides the precautions for nursing.

Director Ouyang kept flipping through the medical history records on the computer: "The communication with the family members is done well, and the family members conceal the medical history, so record it clearly in the medical history records."

Lactic acidosis is a rare complication of diabetes. In the past, phenformin (Jiangtangling) was used to lower blood sugar, which would induce lactic acidosis. Later, this hypoglycemic drug was eliminated, and lactic acidosis became rare.

"How could there be lactic acidosis? Could it be that this patient took Jiangtangling? It's impossible. The banned drugs have been eliminated, and you can't even buy them. The therapeutic dose of metformin will not cause lactic acidosis. There must be other reasons."

Dr. Jin loves learning and thinking very much. When encountering such a case, he will naturally not let it go. As the patient gradually stabilizes, he also wants to find out the reason.

This patient has seizures every year, maybe at some point, it is not impossible to have another attack during hospitalization, the right way is to find the cause as soon as possible.

Lactic acid is an intermediate product of grape metabolism in the human body. The human body has three major nutrients: protein, fat, and sugar. Glucose is a sugar and is the main energy supply for the human body. It provides energy in two ways, one is aerobic oxidation , one is anaerobic glycolysis.

Aerobic oxidation is the main method, which is the main road; anaerobic glycofermentation is the supplementary method, which is the small road. Whether it is taking the main road or taking the small road, it will be decomposed into carbon dioxide and water in the end. Lactic acid is the illegitimate child of glucose taking the small road.

For the anaerobic glycolysis of the glucose pathway to produce lactic acid, the most intuitive experience of the human body is muscle soreness after excessive exercise.

Especially those who do not exercise regularly, suddenly increase the amount of exercise, the energy supply produced by the aerobic decomposition of glucose in the human body is in short supply, and have to start anaerobic metabolism, turn on the horsepower, and replenish energy in an emergency.

At this time, glucose produces an intermediate product under anaerobic metabolism - lactic acid. A large amount of lactic acid has no time to decompose into carbon dioxide and water, accumulates in the muscle tissue, stimulates the nerve endings in the muscle, and causes muscle soreness.

Clinicians, especially surgeons, have mostly returned some basic medical knowledge, such as biochemical knowledge about sugar breakdown, to teachers.

"Under anaerobic conditions, glucose undergoes glycolysis to generate pyruvate, and then undergoes lactic acid fermentation to generate lactic acid; under aerobic conditions, glucose undergoes glycolysis to generate pyruvate, and pyruvate generates acetyl-CoA in mitochondria, and acetyl-CoA then After the tricarboxylic acid cycle, carbon dioxide and water are finally generated; it is also possible to generate carbon dioxide and water through the pentose phosphate pathway. Pyruvate enters the tricarboxylic acid cycle and needs the help of pyruvate dehydrogenase and coenzymes to catalyze it. When diabetes and When you are hungry, both pyruvate dehydrogenase and coenzyme are insufficient, and pyruvate can’t go the big way, so it can only take the short way, so the lactic acid in the blood increases.”

Yang Ping analyzed it to Dr. Jin, not to mention Lao Jin, and Dr. An in the ICU felt a pain in his head when he heard it. Although he usually knows how to diagnose and treat these diseases, but what biochemical pathways and the tricarboxylic acid cycle were developed when he was a student The nerve-wracking things are not needed clinically after work, so naturally throw them all away, otherwise the top of the head will be bald.

Director Ouyang was even more confused. He didn't know what Yang Ping was talking about. On the contrary, the intern doctor who just graduated could understand a little bit, but only limited to understanding.

"I don't know which link went wrong. Glucose was forced to take a detour. If you want to find the reason, you can find it here." Yang Ping wanted to put it in a more general way, but he couldn't.

Taking the big road and taking the small road, the decomposition of glucose was so interesting that the intern quickly took out the booklet and took notes.

Everyone knows that Dr. Yang performed beautifully in surgery, and taught the Japanese how to be human at an academic meeting. Unexpectedly, he has learned all these basic biochemical knowledge so well, and the key is to combine it with clinical application. A good man is a good man.

"Should it be a genetic disease?" Dr. An guessed based on experience.

"You can look into this aspect, but I'm afraid it's not that simple. If there are so many hospitals, if there are genetic diseases related to glucose metabolism defects, they would have been found out a long time ago." Dr. Jin is more cautious.

Dr. Jin is very interested in these difficult and miscellaneous diseases. Last time, he took out the screws for the metal-reactive synovitis, and the pain that had plagued the patient for several years was relieved. This time he is eager to try again and wants to cooperate with Yang Ping. Explore puzzles.

To be rigorous in medicine, this is the way to go, never let go of clues, everything is based on objective evidence, rigorous reasoning and argumentation, and finally unravel the truth.

"Let's build a group and bring in doctors from the Department of Endocrinology." Dr. Jin suggested.

The proposal was immediately approved by the ICU doctor Ann and anesthetist Lao Qin. They are quite academically motivated. As doctors, they are a little more awesome and have a stronger sense of presence.

Director Ouyang didn't want to get involved anymore, it was all young people's business, he didn't have the passion and energy, half of his hair was already gray, if he continued to mess with them, the other half wouldn't be able to keep it.

Dr. Jin immediately set up a group, named it: Medical Detective Agency, and pulled everyone into it.

Wei Danian's case has become the subject of discussion in this group, and lactic acidosis occurs every year. This case itself is very interesting.

Finding the cause of the disease is a huge project that requires a lot of work, and it may not be successful in the end. There are many diseases in the world that cannot be diagnosed every year, and some of them are still undiagnosed diseases in the world.

Wei Danian's blood pressure rose, the acid-base balance was gradually corrected, and the coin flipped the side he wanted again.It was already night when Yang Ping came out of the ICU. Wei Danian's family members were all waiting in the family waiting area outside the ICU gate.

Dr. An came out to talk to them about the illness. Wei Danian's father wiped his sweat and said, "Doctor, you have worked hard. My child has been like this since he was a child. We have always lived near the hospital. This time we moved to your hospital. Pick the one closest to the emergency department."

It's hard to imagine what it's like to be rescued once a year like this. Not to mention the economic consumption, you need to bear huge psychological pressure.Every time I was pulled out of the gate of hell, I don't know when the next time will be.

"We dare not go far away, for fear that there will be no rescue conditions for the disease on the way." The mother said helplessly.

"Since this is the case, why are you still hiding your illness? How dangerous it is." Dr. An blamed the ignorant parents.

"We also thought, anyway, in the hospital, if he suddenly fell ill, he could be rescued, so we didn't dare to mention his condition, for fear that you would postpone the operation, and it would be uncomfortable to see the child lying on the bed screaming." The father smiled awkwardly.

"Now the condition has improved slightly, and the blood pressure has gone up. Further observation is needed, and we still need to find a way to find the cause. You need to sign these." Dr. An put a stack of signed documents on the negotiating table.

"We went to the big hospitals in Shanghai and the capital, but we didn't find any illness. Every time we went out to see a doctor, we were worried. We ran to the hospital as soon as we got off the plane. We don't expect to find out the cause of the disease. We just hope that he is safe and sound. "

Father flipped through these signed documents, he didn't need to look at them, he was very familiar with them, and he knew how to sign them even with his eyes closed.

(End of this chapter)