This doctor has a system

Chapter 393 458. Death caused by rotten coconut
As a newly graduated college girl, as a part-time worker, she always stays up late to have fun, but Li Jing actually has a pretty regular schedule because she has the habit of keeping in shape.

When it comes to work, her roommate thinks she is really hardworking and sometimes sees her sitting in the living room working overtime before going to bed.

Talking about her health, her roommate said that she is in good physical condition because Li Jing was a ruthless prize-winning machine in school sports events in college.

From the current situation, it seems that the patient is indeed a healthy person who cannot write more in his past and personal history.

At this time, the results of the blood gas analysis also came out. The pH was 7.29. The arterial blood gas analysis showed metabolic acidosis. At the same time, her body temperature rose to 39.7 degrees Celsius, and her blood pressure was just measured at 200/110 mm Hg.

High fever? Metabolic acidosis?

"Has she had any infections in the past month, such as cough, fever, etc.?" The emergency room doctor asked Li Jing's roommate again.

The roommate thought thoughtfully for a while, and then said firmly that it was possible. Li Jing should have drank cold medicine earlier this month because the water was too hot to hold firmly, and a cup at home was broken.

Headache, vomiting, blurred vision, high fever, muscle twitching and previous infection history, could it be meningitis?
The doctor who treated the patient in the emergency room obviously had something real in his stomach, and immediately performed a lumbar puncture on the patient.

In addition to routine supportive care, since the results of cerebrospinal fluid laboratory tests will not be available until tomorrow at the earliest, taking into account the patient's condition, the bedside doctor decided to empirically use therapeutic drugs for encephalitis and meningitis (ceftriaxone and Acyclovir).

This time, he heard something new: Li Jing once showed her a rotten coconut after she came out from washing the dishes.

However, the results of laboratory tests of cerebrospinal fluid showed that no blood, white blood cells or protein bacteria and herpes viruses were detected, including culture, all were negative.

This shows that Li Jing did not have an intracranial infection at all.

The patient's condition went from bad to worse, and the doctor in charge of the bed was very worried, so he invited all the big shots to come and take a look.

A director of the infectious disease department was also there, but he also seemed clueless.

The Heilongjiang Sour Soupzi Massacre is a famous food poisoning case. A certain Wang from a community in Heilongjiang and 12 of his relatives had a dinner at home. Nine of them ate homemade Sour Soupzi (made by fermenting corn in water). After growing a thick noodle-like staple food), he caused food poisoning, killing all 9 people.

Everyone looked a little confused, and the director of the infectious disease department quickly explained in detail.

"Are there any common toxins in rotten coconuts?"

"Rotten coconut?" The director of the Department of Infectious Diseases paused for a moment, and his expression suddenly changed.

"It should be outside." The doctor in charge of the bed said. Since Li Jing's parents are far away from here, it will take a few hours to arrive.

"Where's her roommate?"

"Pseudomonas cocotoxin! The massacre of Heilongjiang Suantangzi!"

"It was a ready-to-drink coconut given to us after we returned from shopping in the supermarket. It has been placed on the table in the living room untouched since we bought it. It may have been at least a month. We almost forgot about its existence. Li Jing said at the time She just tasted the water and it was sour, so she spat it out and said she had never tasted such a disgusting taste."

After looking at the specific medications and examinations, Gao Feng couldn't help but give a thumbs up to his treatment plan. This doctor was of very high standard.

Li Jing behaved relatively normally during lunch, but began to feel unwell in the afternoon, which then worsened and she did not go out during this period.

It wasn't intracranial infection. Gao Feng was a little surprised. This was the first thing he thought of.

Meeting her roommate, Gao Feng asked her to recount in detail what they had eaten for lunch.

After carefully combing through all the details related to Li Jing, Gao Feng tried to find out what was missing.

Could it be something you had for lunch?

Rotten coconut? Fresh fruits should be stored at low temperatures, but this open coconut has been stored at room temperature for almost a month, and with the recent hot weather, no one can say for sure what kind of magic culture medium it is for microorganisms.

So, could it be food poisoning?
Gao Feng quickly told Li Jing's roommate to quickly pick up the rotten coconuts at home and send them for examination, and at the same time told everyone about the situation.

The other three people escaped without eating the sour soup because they didn't like the taste. In this case, the mortality rate was 3%!

The cause of such a tragedy is Pseudomonas cocotoxin, a bacterium that commonly contaminates corn and coconuts.

Fermented rice and flour products made in summer and autumn are easily contaminated by this bacteria. This bacterium can produce a fatal toxin - rice enzyme acid, which is the main cause of poisoning in fermented corn flour products, spoiled fresh white fungus and other spoiled starch products. Common foods include glutinous rice dumplings, glutinous rice cakes, millet or Sorghum rice flour products, potato vermicelli, sweet potato starch, etc.

High-temperature boiling cannot destroy the toxicity. There is no specific treatment for poisoning, and the fatality rate is over 50%.

The reason why it is so deadly is that rice enzyme acid is a mitochondrial toxin that mainly acts on the mitochondria in solid organs such as the liver, brain, and kidneys. Mitochondria are the power stations within human cells. Once damaged, there is only one outcome for the cell - "death."

The death of multiple cells is what we know as organ failure, and the failure of more than two organs often indicates that the patient's final survival rate will be a cruel number.

If it was mitochondrial toxin poisoning, then Li Jing's series of symptoms could also be explained: nausea and vomiting, abdominal pain and distension, convulsions, convulsions, hematuria, bloody stools and other symptoms of substantial organ damage to the liver, brain and kidneys.

Abnormalities in the work of cell mitochondria can also explain a series of metabolic disorder symptoms that Li Jing experienced: metabolic acidosis and mild hyperglycemia.

Gao Feng immediately entered the system space. After starting the search, the large screen in the center of the space showed a blank.

This shows that there is no effective treatment method included in the system for rice enzyme acidosis.

Gao Feng's heart began to beat heavily, and his keen intuition told him that Li Jing might not be able to stand up from the bed easily. In fact, before the coconut inspection results came out, Li Jing's situation had already turned bad.

Nineteen hours after admission, Li Jing's brain magnetic resonance imaging showed partial edema in the putamen, hippocampus and cerebellum of her brain. Based on the magnetic resonance imaging results, severe toxic/metabolic encephalopathy was suspected.

Twenty-one hours after admission, new blood test results showed that her blood ammonia level was 21mol/L, myoglobin 100g/L, and creatine kinase 1635U/L. These indicators mean that Li Jing's liver and kidneys are experiencing acute failure, and at the same time, a large amount of muscles are also dissolving. The dissolution products of muscles will destroy the structure of the kidneys, which will further aggravate kidney failure.

28 hours after admission, Li Jing's brain CT showed severe edema in her brain. Since the skull is a closed space, the swollen brain strives to expand in a limited space, which will eventually induce cerebral herniation.

At the same time, Li Jing's pupils began to dilate, her brainstem reflexes lost, and her spontaneous breathing began to gradually disappear.
Finally, 41 hours after being admitted to the hospital, Li Jing was declared clinically brain dead and was no longer of therapeutic significance.

Looking at the howling and crying family members, Gao Feng felt helpless.

In the past, due to the system, he had a lot of trial and error costs. But this time it was obviously different. There was no specific treatment for rice enzyme acidosis, and we could only watch the patient die quickly.

Two days later, Gao Feng received another critical call from the emergency department. Li Jing's doctor in charge told him that the test results of Coconut came out, but the results were beyond everyone's expectations.

Pseudomonas cocotoxin and rice enzyme acid were not found in the rotten coconut meat at all!
Li Jing did not die from rice enzyme acidosis!
What could it be, what could be the fatal cause?

When discussing the death case, the doctor in charge of the bed reported the entire case to everyone in detail, and everyone reviewed every detail of the case in detail:
A young woman fell ill quickly within a few hours after ingesting spoiled fresh fruit. From then on, the condition began to spiral, from vomiting, dizziness, and muscle twitching at the beginning to high fever, high blood pressure, coma, metabolic disorders, and muscle dissolution. , liver and kidney failure. It is characterized by urgency, speed and fierceness.

"It's actually remarkable that rice enzyme acid can be taken into consideration." said the chief director of the Department of Infectious Diseases, who is an absolute authority on infectious diseases.

"I think the direction is good. It is indeed very similar to the chain failure reaction induced by some kind of mitochondrial toxin poisoning. If it is not rice enzyme acid, is it possible that it is a toxin produced by other microorganisms?"

If it’s not bacterial food poisoning, is it possible that it’s fungal food poisoning? Gao Feng's heart skipped a beat, and he proposed the idea on the spot.

"It's very possible!" The chief director of the Department of Infectious Diseases glanced at him approvingly. The young man's idea coincided with his. The patient's condition was indeed consistent with fungal food poisoning.

In the laboratory, inspectors re-examined the coconuts and discovered a fungus: Rhizoma cane.

When it comes to this fungus, most people may be unfamiliar with it. Arthrospora is a type of mold that is uncommon in nature. It is a plant saprophytic fungus distributed all over the world.

Arthrosporium is distributed in sugarcane samples from sugarcane producing areas (Guangdong and Guangxi) and areas where spoiled sugarcane poisoning occurs (mainly in northern areas). I believe many people have heard about the toxicity of red sugar cane:

Red sugar cane is often caused by the fungus Arthrospora cane, which produces a highly toxic substance: 3-nitropropionic acid (3-NPA).

As a mitochondrial toxin, 3-NPA can irreversibly bind and inhibit succinate dehydrogenase in mitochondria, thereby blocking the citric acid cycle and ATP production in cells.

To explain in more layman terms, when 3-NPA is present, the cell's mitochondria will not choose to use normal substances for energy production, but preferentially select the toxin. As a result, energy production in the cell is forced to cease. .

The tragedy of 3-nitropropionic acid poisoning due to ingestion of spoiled red sugar cane is also not an accident.

If Li Jing indeed ingested this toxin from moldy coconuts, it would explain the severe acidosis and series of symptoms observed.

The highly toxic mitochondrial toxin interfered with the energy supply to her brain, causing her first obvious neurological symptoms: dizziness, blurred vision, and muscle twitches.

This is followed by interference with metabolism, and metabolic disorders of acidic substances lead to the emergence of acidosis. Massive death of liver cells leads to liver failure, and muscle cells begin to die and dissolve after energy depletion, which will further aggravate the collapse of the kidneys.
Finally, in the second test of Li Jing's blood sample, the inspector also discovered the presence of 3-NPA.

The girl finally took a sip of moldy coconut water and stayed at the beginning of spring forever.

Gao Feng's heart is very complicated. If he applied antifungal drugs earlier, would it have changed the outcome?
Most likely it's not possible, the condition is progressing too fast.

In fact, the older generation has the habit of eating leftovers, and they don’t take the young people’s advice seriously——
Today, Gao Feng followed Zhang Zhengye to a free clinic at the community hospital. This was a task organized by the committee. Without special reasons, every department had to send people to participate.

The community hospitals in Beijing are obviously different from those in Hnan Province. The community hospitals here are much stronger. Seeing several 20-story buildings rising from the ground, Li Youliang couldn't help but smacked his lips.

"This is higher than the building of our county hospital." He came back after walking around and said, except that the site is a bit smaller, the other configurations are not low at all.

Community hospitals in Beijing are not just vaccination places like those in many areas. The medical work they can undertake here is much higher.

At least common surgeries were no problem. Gao Feng also saw Olympus gastroenteroscopes and bronchoscopes in the endoscopy room. Although there are only two in number, they are fully equipped.

The free clinic was very lively. There were many residents nearby, mostly old men and women who could sing and dance rap.

Many people are literate at first glance, and their behavior and conversation are extraordinary. If they don't receive a pension of more than 6000 yuan a month, their mental outlook will not be so good.

Gao Feng saw several patients, most of whom had chronic obstructive pulmonary disease. They smoked too much when they were young, so it is natural for them to suffer from such diseases when they get older.

One of the patients was in the acute attack stage, probably due to pneumothorax. The chest tightness was obvious at this moment, so Gao Feng asked him to go to the hospital for treatment quickly. The other patients were relatively stable and only needed to take medication on time.

There was also a family member of a patient who came for consultation. His father had advanced lung cancer, and his pathological type was squamous cell carcinoma. He had undergone radiotherapy and chemotherapy before, and now he seems to have relapsed.

"Doctor, does Union Medical College have any new drugs now?" the family member asked, "My dad almost couldn't survive the chemotherapy before, but this time he is unwilling to go again."

Gao Feng looked at the patient's medical record. The patient had a genetic test and found no genetic mutations. Targeted drugs were not considered.

(End of this chapter)