Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 266 Suddenly fainted!

This is a bit dangerous. In short, I feel that it is a disease that can synthesize the symptoms of the whole body. "

Wu Jiang was stunned: "What kind of disease can cause a chain reaction in the whole body?"

Wu Jiang muttered while thinking.

"Edema, dark urine, anemic face, gastrointestinal symptoms, and high blood pressure..."

Suddenly, only Lin Yi said slowly:

"I suspect that he had nephritis in the early stage, but it dragged on for a long time, causing kidney failure."

"Ah?! Kidney failure? Such a young man? No way! I see that he is only 24 years old on his ID card."

Wu Jiang was surprised and couldn't believe it.

Kidney failure for such a young guy? ?

"That's right, not only kidney failure, but also early symptoms of uremia."

Hearing this, Wu Jiang thought more and more that it was possible.

The urine he said is darker than tea color is already close to hematuria!

There is also edema, which can appear in the early symptoms of renal failure and uremia.

There are also high blood pressure, anemia, and even bone disease and so on.

These are all renal failure, that is, systemic reactions caused by kidney strikes!

"Oh my god, hearing what you said, I also think it's kidney failure!"

While the two were thinking, a patient with a gastric ulcer came in with a checklist:

"Doctor, I have the results. This is the result of the gastroscopy, and this is the air blow test."

Lin Yi took the checklist and looked at it.

In the two pictures of the stomach on the gastroscopy list, two small sunken ulcers appeared in each folded gastric curvature.

Carbon-13 breath test, 30-minute DOB value > 23.0.

Carbon 13 is considered positive as long as it exceeds 4.0.

So this person is a Helicobacter pylori-infected gastritis, and then slowly developed into a gastric ulcer.

It is not impossible to cure Helicobacter pylori. Combined with antibiotics, the symptoms will be relieved a lot after taking it for half a month.

Also take medicine to suppress stomach acid.

Helicobacter pylori can accelerate the secretion of gastric acid, so it will cause ulcers.

If you insist on taking the medicine and keep your stomach healthy, the ulcer can still be cured.

While prescribing the checklist, Lin Yi told the patient:
"Go back and take your medicine on time. Wait a month after a course of treatment and then come back for a reexamination. In addition, this disease is contagious. If you have it, there is a high probability that your family will also have it. Remember to bring your family over for a checkup. Remember to go back to eat Use serving chopsticks."

The patient nodded and left the consulting room with the list.

When it was time to go to lunch at noon, the young man with kidney failure hadn't come back yet.

This made Lin Yi a little worried.

From Lin Yi's point of view, this person is indeed suffering from kidney failure.

It is still chronic renal failure, and the degree of atrophy of the right kidney is more serious than that of the left kidney.

I don't know how this guy was so tolerant in the early days? !
He actually delayed coming to the hospital for treatment until severe hematuria appeared.

Hey!
The more I think about Lin Yi, the more regretful I feel.

This young man...is not curable!
So Lin Linyi and the two went out to eat,
As soon as he walked out of the consulting room and came to the corridor, there was a sudden exclamation:
"Come to the doctor! Help, someone has fainted!"

Lin Yi and Wu Jiang looked at each other.

this sound...

Why is it a little familiar?

It was like the voice of the girl in the consulting room in the morning.

I didn't even bother to eat lunch right away.

Lin Yi and Wu Jiang hurried forward.

It turned out that it was the guy with kidney failure and the girl who came to the hospital with him.

The guy was falling to the ground with his eyes closed!

The girl was also squatting on the ground and yelling: "Wuuuu...doctors, come and take a look! He's fainted!"

Lin Yi rushed forward with a stride.

It was found that the boy's carotid artery pulse disappeared, which was unbearable.

Sudden ventricular arrest!

That is sudden death!
It must be rescued quickly!
Lin Yi said to Wu Jiang while doing cardiopulmonary resuscitation:

"Hurry up and push the flatbed cart over to the emergency room! This man is in ventricular arrest!"

Upon hearing this, Wu Jiang quickly borrowed a flat car from the B-ultrasound room next to it.

The two carried the boy onto the flat car, while Lin Yi ran along with the flat car while pressing.

"Quick! Make way! Please make way!"

The family members who passed by saw the situation and consciously stepped out of the way.

On the other side, the doctor on duty in the emergency room heard the sound of hurried footsteps and the sound of the wheels of the flat car from a long distance away.

Looking outside, I saw that it was Dr. Lin and Dr. Wu who were pushing the patient to the emergency room.

The staff on duty then consciously pushed the emergency medicine cart over.

"Oxygen, ECG monitoring, and intravenous access are all on!"

"One epinephrine, one each of Lobeline and dexamethasone!"

Lin Yi ordered immediately after walking into the emergency room.

"Ok!"

As soon as Lin Yi spoke, the two nurses in the emergency room immediately took action.

After the medicine was injected, the heart rate and breathing were significantly improved.

But the heart compressions can't stop.

You have to persist until the boy regains his own heartbeat and breathing.

"Add another lidocaine!"

"Ok."

Six minutes later, the rescue was successful.

The boy's heart resumed beating on its own.

Lin Yi also breathed a sigh of relief.

Kidney failure does cause sudden death.

The cause of sudden death was hyperkalemia.

The kidney has two main functions, one is filtering function and the other is endocrine function.

The urinary system of the kidneys is like a sieve of the human body.

After the blood passes through the kidneys, the metabolic wastes in it, such as urea nitrogen, creatinine, uric acid, etc., will be excreted with urine.

The protein, fat and other substances will remain in the body.

Screen out the bad ones and keep the useful ones. This is a normal kidney filtering function.

However, when the kidney fails, the filtration function is damaged, and creatinine, uric acid and blood urea nitrogen cannot be excreted. The long-term accumulation of these things will cause acidosis, edema, elevated blood uric acid, and electrolyte imbalance.

Among them, the accumulation of potassium ions cannot be discharged, which will cause hyperkalemia.

(Hyperkalemia can easily cause arrhythmia and sudden death.)
Then there is the endocrine function.

When the kidneys are damaged, they secrete a substance called renin.

Originally, renin is normally secreted, and under normal circumstances it will not cause harm to the human body.

But once the kidneys are damaged, the blood flow to the kidneys is reduced, and the endocrine nerves in the kidneys are out of balance, renin will be secreted uncontrollably in large quantities.

Once the renin is high, the blood pressure will also increase, so it becomes renal hypertension.

(The reason for this patient's high blood pressure at a young age.)
In addition, the kidneys secrete erythropoietin under normal circumstances.

Once the kidneys are damaged, erythropoietin decreases, and red blood cell production disorders lead to anemia, which becomes renal anemia.

(The reason for this patient's anemia.)
In addition, the kidney also has an important endocrine function, which is to activate vitamin D3.

Most of the vitamin D3 in the human body is synthesized through ultraviolet radiation.

(Food D3 content is very small, it is better to get out of the sun frequently.)
After vitamin D3 is produced, it goes through the liver for the first round of activation.

After the second round of activation by the kidneys, the vitamin D3 after kidney activation is truly biologically active.

In order to participate in the body's metabolism, enhance immunity, and promote calcium absorption.

When the kidneys are damaged, active vitamin D is deficient, and calcium is poorly absorbed.

Therefore, various bone diseases, osteoporosis, etc. will appear.

These are a series of reactions in the body caused by kidney failure.

This patient is now suffering from sudden ventricular arrest, which means that the blood potassium level in the body exceeds the standard.

The primary treatment is to expel potassium ions as soon as possible!
However, the kidneys have been damaged and potassium ions cannot be excreted in the urine, so dialysis is the only option.

Uremia is a general term for late stage symptoms of renal failure.

Hemodialysis is to filter the harmful substances in the blood that cannot be excreted by the kidneys, and then reinfuse them into the body.

"Lin Yi, why did this person die suddenly? Could it be an electrolyte disorder caused by kidney failure?"

Lin Yi nodded:

"The combination of several symptoms is indeed similar to renal failure, and it should be sudden death caused by high potassium after electrolyte disturbance."

After finishing speaking, Lin Yi turned his head to look at the family members and asked:
"Did he urinate just now? Have you had a urine test?"

The girl cried and shook her head:
"No...no, I can't urinate... just a few drops."

"Are you his wife? Let me make it clear to you first. Although we have pulled him back from the gate of hell, the situation is still not optimistic."

After the girl glanced at Lin Yi, she kept crying.

While crying, she begged Lin Yi to save her.

Just at this time the patient's blood test results came out.

Blood routine:

白细胞：16x 10/L（(4.0-10.0)x 10/L）

红细胞计数：2.5×1012（3.5-5.5×1012）

Determination of hemoglobin: 98g/L (normal male 130-170g/L)

After a routine blood test, it is basically confirmed that it is anemia.

Hemoglobin determination is the main basis for confirming whether a patient is anemic.

正常男性130以上都算正常，低于120-90就算是轻度贫血，90-60属于中度贫血，30就算重度贫血。

Kidney function:

Serum creatinine value: 588μmol/L (50-120μmol/L)

Glomerular filtration rate: 20ml/min (90-120ml/min)

Looking at these two results can basically determine the degree of kidney damage and whether it belongs to uremia.

(The values ​​of blood urea nitrogen and uric acid are unstable and are easily affected by other factors, so the diagnosis of uremia basically depends on creatinine and glomerular filtration rate.)
Normal glomerular filtration rate is 90-120ml per minute.

This guy is already 20!
If it is lower than 15ml/min, even if it is end-stage renal disease, you can only rely on hemodialysis to maintain your life.

Electrolyte:
Potassium ion: 6.8mmol/L. (3.5-5.5mmol/L)

Sodium ion: 152mmol/L. (135-145mmol/L)

Chloride ion: 103.3mmol/L. (98-107mmol/L)

Calcium: 2.0mmol/L. (2.10-2.55mmol/L)

Potassium, sodium height, calcium decrease, belong to electrolyte disorder.

Wu Jiang glanced at the checklist and said:
"Potassium is 6.8! Coupled with such a low glomerular filtration rate, potassium must not be excreted! How can this be done? He needs to go for dialysis, otherwise this young man will be very dangerous."

The girl next to me cried again and asked:
"Doctor, what's wrong with him? What's wrong with him? Is it serious?"

Lin Yi glanced at the girl and said helplessly:
"The initial diagnosis is severe damage to the kidneys, that is, renal failure, with inflammation, and the high probability is already in the uremia stage."

"What... what? Urine... uremia?!"

Even those who don't study medicine have heard of uremia.

Such a serious disease would not survive without a kidney transplant!

After thinking about it, the girl began to cry heartbreakingly.

While crying, he lay on the boy's body.

Still muttering in his mouth:

"Woooo...wake up, woooo...don't die...what will I do if you die..."

Lin Yi quickly helped her up to comfort her:

"Don't get excited, he has been rescued now. The next priority treatment is to get dialysis treatment as soon as possible.

Otherwise, if there are too many harmful substances in the body and cannot be discharged, it will only become more and more serious, and the same situation as before will happen.

How about this, you go to the bill payment office to be admitted to the hospital, and we will arrange for dialysis right away. "

The girl sniffled and asked:

"Doctor, how much do you have to pay for this?"

"Does he have medical insurance? Dialysis usually costs more than 500. If he has medical insurance, he can reimburse the bill."

"Some have medical insurance."

"Then you don't have to worry about it. After calculating the medical insurance, you may pay more than 100 yuan yourself."

The girl was relieved when she heard Lin Yi say that.

He hurriedly took his ID card to go to the hospital for admission.

Soon, Lin Yi also notified the nephrology doctor to come down for consultation.

There were two doctors who came, one was Wang Guang and the other was Song Feng.

"This is the patient's checklist. Blood routine, liver and kidney function, hyperthyroidism, and electrolytes. All indicators are abnormal. The initial diagnosis is severe renal impairment, and symptoms of uremia cannot be ruled out."

Lin Yi handed the checklist to Wang Guang.

Behind him, Song Feng quietly glanced at Lin Yi and then quickly lowered his head.

The gap is getting bigger and bigger, how could Song Feng have the nerve to compare with others...

Just obediently be a little transparent!
Just as he was talking, the patient's color Doppler ultrasound and CT results came out.

CT showed no obvious pathological changes in the lungs.

However, there is a problem with the color Doppler ultrasound. The size of the kidneys is smaller than normal, and the cortex and medulla are not clearly decomposed and thinned, and the reflection intensity of the entire kidney is enhanced.

Lin Yi handed the list to Wang Guang:

"Now there is only one urine test result missing, but this guy can't urinate, but just looking at the existing checklist can already confirm that it is kidney failure."

Wang Guang nodded while looking at the result:

"Song Feng, you go and inform them and ask them to bring the dialysis machine to the emergency room, do a dialysis first, and then send them to the department for hospitalization after the electrolytes recover."

"Ok!"

Song Feng immediately ran to make a call after responding.

Soon, the bedside dialysis machine and the family members who went to pay the fee came over.

Wang Guang looked at the girl and asked:
"Are you a family member? His wife? Come here to sign. He is now critically ill. You have to sign a critical illness notice."

When the girl heard this, big tears fell down again. After hesitating for a while, she said:
"I can sign, but...but I'm not his wife, I'm his girlfriend, and we're not married yet."

"What?" Lin Yi was taken aback, but she didn't deny when he asked if he was his wife just now.

Wang Guang hurriedly urged her to say:

"So, hurry up and call his family. He is in a serious condition now. Do you know that he has kidney failure? Chronic kidney failure, and he has already shown symptoms of uremia.

The condition must be stabilized quickly, otherwise it will be very dangerous.

We will definitely take him when he is critically ill.

Our hospital also needs a family member who can take responsibility to sign, so please inform his parents as soon as possible. "

The girl asked with a tangled face:

"I'm his girlfriend, I can make decisions and take risks, just let me sign it!"

(End of this chapter)