This doctor has a system

Chapter 237 225. Hypokalemia; pay, 77

"Doctor, come and take a look. My dad is stupid." A middle-aged man hurried to the doctor's office.

"Is he our patient?" Gao Feng asked.

"It doesn't look like it. I have never seen this family member." Dong Qianqian said.

"My patient." Qin Hao stood up hurriedly, "Are you the son of bed 35? What's wrong with the old man?"

"His eyes were dull, and he didn't pay attention to anyone he was talking to. He didn't know where he was." The patient's son looked anxious, "Just now he said he wanted to vomit."

"Let's go and take a look." Qin Hao stood up.

"Strange condition: Ma Dongshan's hemoptysis situation had already improved, but the sudden onset of mental symptoms cast a shadow over subsequent treatment. Please help him clarify the cause of the disease in time. You can get 15 skill points by completing the task. "

"Let's go too." Gao Feng said.

The patient, Ma Dongshan, male, 72 years old, went to the hospital with the main complaint of recurring cough, sputum, and hemoptysis for more than 10 years, which occurred again for one day.The patient had recurrent cough, sputum, and hemoptysis for more than 1 years. He was diagnosed with bronchiectasis, and his symptoms were relieved after symptomatic treatment.

One day before admission, he had hemoptysis several times without obvious triggers. The color was bright red and the total volume was about 1 mL. He was admitted to the hospital with bronchiectasis and hemoptysis.

Physical examination: stable vital signs, clear mind, acute facial appearance, slightly cyanotic lips, and centered trachea.The thorax and intercostal space were normal, the breath sounds in both lungs were thick and scattered moist rales could be heard, there was no edema in both lower limbs, and the rest of the physical examination was unremarkable.

Auxiliary examination: blood gas analysis: oxygen partial pressure 64 mmHg, carbon dioxide partial pressure 50 mmHg; electrolytes: serum potassium 3.55 mmol/L, serum sodium 135 mmol/L, other blood routine, coagulation function, PCT, D-dimer, liver and kidney function There were no obvious abnormalities in heart and heart function indicators; chest CT showed left lung bronchiectasis and infection.

The diagnosis on admission was: bronchiectasis combined with hemoptysis.

This disease is very common. Qin Hao did not pay too much attention to it when he received the diagnosis. He routinely discussed the disease with the family members and informed them of the risk of massive hemoptysis.

After admission, the patient was required to stay in bed to keep his respiratory tract open.For treatment, the antibiotic piperacillin-tazobactam sodium was given to fight infection. After intravenous infusion of 6 U of posterior pituitary injection, 24 U + 50 mL of normal saline were administered intravenously at a rate of 5 mL/h, supplemented by Expectorant, rehydration and other treatments.

Today is the fifth day since the patient was admitted to the hospital, and the current situation of hemoptysis has improved significantly.

"Doctor, what's going on?" Ma Dongshan's daughter said dissatisfied, "It was fine when we came here, isn't it broken by us?"

"Yes, there is nothing wrong with them." Another family member also echoed.

"I'm not sick. Why did you come to the hospital?" Qin Hao immediately asked, "Are you here for a trip?"

Ma Dongshan's daughter was choked to death. "What's your attitude? Does anyone talk like this? Do you have medical ethics?"

"That's my attitude. Don't ask me whether I have medical ethics. Do you have medical ethics?" Qin Hao's voice was louder than his. "When the old man first came here, he vomited blood and screamed. Isn't this called not sick??? "

"If you don't have good eyesight, don't talk nonsense."

"I want to file a complaint against you!" The family members were very angry.

"Go quickly, I beg you, go quickly." Qin Hao is not used to her at all. He works as a doctor in a tertiary hospital. If you say that you have never been complained about, you will be embarrassed to say hello to others when you go out to eat.

"Okay, okay." The patient's son couldn't stand it any longer, "The old man is so stupid, so don't argue with the doctor." He seemed to be a sensible person.

"Doctor Qin, please calm down and show my dad what's going on first."

"Stand aside!" Qin Hao said to the patient's daughter with a stethoscope, "What do we think of you standing there?"

Gao Feng was shocked. Is Qin Hao so strong?I've never seen him like this before.

"Qin Hao is angry. This patient is an acquaintance of a leader in the logistics department, and he is arrogant all day long." Dong Qianqian explained in a low voice, "The family members curse every day and always find fault with the nurse."

"I called the head nurse last night and told me to arrange for someone to come over and wipe the old man's butt."

The head nurse was so angry that she laughed. She immediately called Qin Hao and cursed him.

"Look what you got?"

"Go wipe his ass!"

"Everyone else's patients are fine, but you are always doing these nonsense."

"What are you doing all day? What class are you in?"

Qin Hao was stunned by the scolding at that time. He had spent a whole night mentally building up his mind, but he still hadn't gotten over his anger. His family members were acting like monsters here again. How could he bear this?
"If you have a problem with us, you should file a complaint and transfer him to another hospital!"

The family members of the patients in the next bed couldn't help but say a few words, "It's just that they are still messing around here every night, and we can't sleep well."

"There must be something wrong with her brain. I think that woman should go to a brain department to have her brain checked."

The patient's daughter was furious, but she didn't dare to talk back when she saw that the person speaking was an elder brother with tattoos on his arms.

It seems there is nothing wrong with his brain, Gao Feng thought.

"Old man, what's your name? Where do you live from?"

When the patient heard his voice, his eyes seemed to focus. He thought hard and replied, "I don't know."

The patient was now unresponsive, his eyes were dull, his cognition declined, he was also accompanied by nausea and vomiting, and the vomited material was a small amount of stomach contents.

"Here, let me conduct a neurological examination on him." Gao Feng stood up. He was also curious about what was going on with this patient.

The muscle strength of the patient's upper and lower limbs decreased to varying degrees, but the muscle tone was normal, and no other obvious abnormalities were found.

"How about an emergency head CT?" Qin Hao looked at Gao Feng.

"Okay, check all the blood before going down, especially the electrolytes."

Gao Feng suspects that the patient's mental changes are related to electrolyte imbalance. If the blood sodium is very low, it may lead to hyponatremic encephalopathy.

The disease can manifest as dizziness, blurred vision, mental disorder, disorientation, ataxia, epileptic seizures, alternating drowsiness and agitation, and even coma.Symptoms of increased intracranial pressure, such as headache, vomiting, and slow heart rate, may also occur.Correction of hyponatremia may relieve symptoms.

Watching the nurse bring in seven or eight blood collection tubes, the patient's daughter frowned and said, "I just know how to draw blood. In the past, experts could tell what the disease was by taking a pulse, but now doctors know how to rely on machines and tests."

"You're not very capable, but you have a bad temper."

Damn it, if Qin Hao hadn't been in a hurry to contact the imaging department for a check-up, he would have fought with her again.

The results of the head CT came out quickly and no major abnormalities were found.

However, the results of the blood draw showed that the blood potassium was 2.42 mmol/L (normal value 3.5-5.5mmol/L), which was significantly lower than normal, and other results were normal.

"Why does hypokalemia occur?" Qin Hao was a little puzzled. The patient had been eating normally these days, eating more than at home. "Are you using diuretics?" Dong Qianqian asked. Some commonly used loop diuretics have the effect of excreting potassium and can cause patients to suffer from hypokalemia.

"Useless."

"That's quite strange." Dong Qianqian said.

"It should be an adverse reaction to pituitary hormone." Gao Feng thought about it and expressed his opinion.

"Strange condition: You completed the task and obtained 12 skill points."

"Everyone knows that there are three main reasons for hypokalemia: insufficient potassium intake; excessive potassium loss; and abnormal potassium distribution in the body."

When the patient was admitted, his electrolytes were normal, his appetite was acceptable, and there were no long-term fasting, gastrointestinal obstruction, or other causes of insufficient potassium intake; there were no vomiting, diarrhea, or other causes of excessive potassium loss;

Complete adrenocorticotropic hormone, aldosterone, free/total triiodothyronine, free/total thyroxine, thyroid-stimulating hormone, renal function and other related tests are all normal, and the circadian rhythm of plasma cortisol is also normal. Kidney disease or metabolism cannot be used Disease explains hypokalemia, so drug-induced hypokalemia cannot be excluded.

"I have read some literature before, which mentioned that a patient developed hypokalemia 1 week after being pumped into the pituitary gland. The other drugs used by the patient, such as piperacillin, tazobactam sodium, and ambroxol Injections, tranexamic acid, white-browed snake venom hemagglutinin, etc. have rarely been reported to cause electrolyte imbalance in previous literature.”

"What is the mechanism by which pituitaryin causes hypokalemia?" Qin Hao still had questions in his mind.

Gao Feng smiled slightly, "The active ingredient of pituitary hormone, antidiuretic hormone, increases the reabsorption of water by the distal convoluted tubule and collecting duct, reduces the discharge of water, and significantly increases the total body fluid volume, leading to dilutive hypokalemia."

There are many symptoms of hypokalemia. Hypotassia is the earliest and most prominent symptom of hypokalemia, which can manifest as general fatigue, lethargy, etc. It can also manifest as digestive system symptoms such as abdominal distension, weakened/disappeared bowel sounds, and Irregular heartbeat, tachycardia, atrial fibrillation and other cardiovascular system symptoms.

Of course, sometimes it can also manifest as dull vision, reduced ability to distinguish, and gastrointestinal discomfort such as nausea and vomiting.

Qin Hao immediately stopped the patient's pituitary hormone and gave him intravenous potassium supplementation. The electrolytes were rechecked 2 days later, which showed that the serum potassium had returned to normal, the patient's consciousness had recovered, and there was no further discomfort such as nausea and vomiting. The electrolytes were rechecked many times and were normal.

"When using pituitary hormone, it is recommended to appropriately limit water intake. After starting treatment, you should start monitoring 24-hour intake and output, which will help early detection of electrolyte disorders including hypokalemia. It is recommended that water intake should not exceed 800 ~ 1500 mL/d, and appropriate potassium supplementation based on urine output.”

"Pituitaryin can cause a variety of electrolyte disorders, but most of the previous reports were hyponatremia. Reports of hypokalemia are rare and easily ignored by everyone. Therefore, in addition to paying attention to low sodium when using pituitary glands, it is also necessary to closely monitor serum potassium. If hypokalemia occurs, the pituitary gland should be stopped immediately, and an alternative plan can be developed based on the degree of hemoptysis and potassium deficiency."

"Have you learned it?" Gao Feng said happily. He likes to popularize medical knowledge with everyone.

"I'm done with my studies," replied the trainee below.
-
"Quick, Wang Liang, Hu Gong wants everyone to gather below." Someone shouted, "Where is Lao Yue?"

"Going to eat." Wang Liang was busy chatting with his girlfriend Liu Fang.

"I'm on the toilet. I want to eat your uncle's head." Yue Penghui's voice came from the toilet.

"Stop eating, hurry up, Mr. Hu is waiting below." The colleague urged, "It's a good thing."

I have to finish this great thing, bah, finish it!Yue Penghui thought to himself.

No matter how great a good thing is, it still has to allow me to talk to my baby a little more, Wang Liang thought to himself, the two of them were discussing the date of their wedding.

"It is said that the bevacizumab project is going to give out bonuses." The colleague's face was red. "I saw a cash transport truck coming down below. Isn't it asking for cash?"

What? ? ?
Yue Penghui almost pulled up his pants, "Wang Liang, the toilet is out of paper, hurry! Pass me a pack."

Wang Liang didn't care about him at all at the moment and ran away with his colleagues.

"Fuck!" Yue Penghui was furious.

Finally, Gong Fan, who heard the noise, came over and threw a pack of toilet paper at him, "What are they doing?" Dr. Gong was very puzzled, as if they were all given chicken blood.

"The bevacizumab injection project we did before has now passed clinical trials, and the company said it would pay bonuses." Yue Penghui quickly put on his shoes.

"As for it?" Gong Fanshun was very puzzled. How much money can he get?They were running around like monkeys.

He picked up his cell phone and called Lu Yingtao. As soon as he got through, he heard the other party's exaggerated voice, "Come on, Lao Gong, Hu Gong is here to distribute money to everyone."

"Fuck!"

"Fuck!"

Gong Fanshun

What the hell are you doing there? You don’t have a dime, and Gong Fanshun is also drunk.

"Today is a good day." Hu Jiaran told everyone happily, "The bevacizumab injection we worked on before has now passed the clinical trial."

"The project has brought great benefits to the company, and the company will certainly not forget everyone's contribution."

"I made a promise from the beginning. I, Hu Jiaran, am definitely not someone who talks nonsense. I will distribute this money to everyone today."

"Originally, I thought about paying everyone directly to the card, but when I went back and thought about it carefully, I felt that it would be better to pay in cash. It's such a joy."

Zhao Xingye in the audience curled his lips, "You have so many tricks, but you are just looking for trouble for me."

Gong Fanshun also came to the lobby on the first floor at this time, "Fuck! Fuck!" He couldn't help shouting.

As you can see, in the middle of the hall is a city wall built with hundred-dollar bills. Gong Fanshun feels that this is the most beautiful wall he has ever seen in his life. Although it is not very high, it is still crooked.

"Zhou Wei, 17."

"Xu Bing, 18."

"Wang Liang, 34"

Wang Liang's hands were shaking so much that he took off his shirt and started to take money from it.

"1.2.3.434.35.36"

"Wang Liang, you took too much!" Cao Wenbin, who was in charge of counting, became anxious.

"Yue Penghui, 77."

There was a loud bang in the audience, "Damn it, this bitch Lao Yue is getting rich!"

"Why are there so many of them?" A new employee was shocked.

　I see some brothers reading at night, which is very harmful to the body.

　　
　
(End of this chapter)