A hundred days after signing in, the first surgery shocked the world!

After sending off the mother and son, Lin Feng went home.

Got a good night's sleep.

......

Came to the hospital the next day.

And then the day began.

The first patient was also a mother with a child.

The child is six or seven years old.

Just looking at his face, Lin Feng didn't notice anything abnormal.

And don't wait for him to ask.

The child's mother then said, "Doctor, show my son that he has high blood pressure!"

What the!!

Hypertension!

This child is also in the first grade, how can he have high blood pressure.

Lin Feng immediately asked, "How do you know that your child has high blood pressure?

Asking this question, the main reason is that Lin Feng is more puzzled.

There is nothing unusual about the little ones.

If there are no symptoms, how will adults know that children have high blood pressure!

Immediately, the child's mother began to explain.

It turned out that this child had just been in the first grade, learned to use an electronic blood pressure monitor to measure blood pressure, and measured his parents and grandparents at home.

Finally, I tested myself.

The result was unexpected.

The sphygmomanometer reported a value of 150/100mmHg.

This frightens the parents of the child.

At first, I thought that the sphygmomanometer was broken, and after repeated measurements several times, it was determined that it was the child's high blood pressure.

This hurried to the hospital.

High blood pressure in children is indeed difficult to accept.

It also made Lin Feng highly cautious.

The child was admitted to the hospital room and connected to ECG monitoring.

According to the above data, the patient has high blood pressure without any other uncomfortable symptoms, which may have lasted for a long time.

The patient's mental response is good, and there is no edema all over the body;

rosy lips, no hyperemia in the pharynx, no enlargement of the tonsils;

normal breath sounds in both lungs;

Regular heart rate, powerful heart sounds, no murmur;

Soft abdomen, no tenderness throughout the abdomen;

There were no abnormalities in blood routine, liver and kidney function, blood lipids, blood sugar, electrolytes, and myocardial enzymes.

Noncontrast CT scans of the abdomen, urinary tract, and adrenal glands are all normal.

Now it's weird.

Everything is normal, but this patient's child has high blood pressure.

This made Lin Feng more cautious.

To talk to the child's mother, he needs to understand the child's living environment, whether it is caused by the high blood pressure caused by the environment.

After careful conversation, I learned that the child's grandfather was engaged in battery manufacturing.

And the child has been living with his grandparents and has high lead environmental exposure.

It was immediately suspected that the child was high blood pressure caused by lead poisoning and excessive blood lead.

As we all know, lead is a heavy metal, widely used in industry and life, in the human body without any physiological function, the nature is very stable, not easy to degrade and metabolize.

There is no safety threshold for harm to children, and even long-term low-dose lead exposure can cause mental decline and behavioral disorders in children.

Generally, lead poisoning is mainly occupational groups, while people with lead poisoning in life lack a clear history of lead exposure and atypical symptoms, resulting in a very high rate of misdiagnosis.

There are generally three routes of lead poisoning:

Digestive system (inorganic compounds of lead), respiratory system (inorganic lead particles), and skin contact (organic alkyl lead).

90% of the lead entering the human body is stored in the bones, and 10% will be distributed to various tissues and organs throughout the body with the flow of blood circulation, causing damage to multiple systems of the body, especially the nervous system and hematopoietic system.

Lin Feng immediately decided to conduct a trace element test on the patient's children.

The results of the examination did not surprise him.

Trace element lead 311μg/L

Trace element calcium 1.56mmol/L

Trace element magnesium 1.51mmol/L

Trace element copper 10.74μmol/L

Trace element zinc 70.23μmol/L

Trace element iron 8.61mmol/L

It is very obvious that the blood lead is exceeded.

That shows that Lin Feng's judgment is not wrong.

The patient is lead poisoning.

The susceptibility of children to lead poisoning is mainly related to its own characteristics: high absorption rate, low excretion, and high mobility in the body.

Lead is mainly present in the environment in the form of dust and dust (most of them are gathered at about 100cm above the ground), the closer to the ground, the higher the lead concentration, and when the environment is polluted with lead, children inhale lead concentrations much higher than adults.

Children grow and develop rapidly, the amount of food intake per unit body weight and lung ventilation are higher than that of adults, and the lead intake and lead inhaled from the air are relatively more; the emptying of children's gastrointestinal tract is faster than that of adults, and the lead absorption rate will increase significantly in the fasting state, coupled with children's hand-mouth movements, will lead to high lead absorption rate in children's gastrointestinal tract.

Adults can also excrete most of the lead through reactions such as spit, and children are not yet mature to form this reaction; 99% of the lead in the adult body can be excreted with urine, and children can only excrete 2/3.

The accumulation of lead in children's bones is also highly fluid and easily flows into blood and soft tissues, increasing endogenous lead exposure in children.

Blood lead level is the "gold standard" of lead poisoning in children, two consecutive venous blood lead levels of 100~199mg/L, diagnosed as hyperleademia, two consecutive venous blood lead levels ≥ 200mg/L, is lead poisoning.

Lead poisoning is generally divided into three grades.

Mild lead poisoning: blood lead level 200~249mg/L

Moderate lead poisoning: blood lead level 250~449mg/L

Severe lead poisoning: blood lead level equal to or higher than 450 mg/L (if blood lead is equal to or higher than 700 mg/L, it will be accompanied by lead poisoning encephalopathy)

When she heard that the child was poisoned by lead, the child's mother was very worried.

Lin Feng immediately comforted two words and formulated a treatment plan.

Lead repellent therapy for moderate and higher lead poisoning requires lead repellent, and pediatric lead poisoning can be more aggressive given that lead can also adversely affect children at low levels.

The normal regimen should be oral dimercaptosuccinic acid, each course of 19 days, 350mg/㎡ each time, 3 times a day for the first 5 days, and 2 times a day for the next 14 days.

Or use calcium sodium edetate.

Intravenous or intramuscular injection, 1000mg/㎡, a course of 5 days.

Five days later.

Patients will need to be retested for blood lead because bone lead is released into the blood after stopping the drug.

Appropriate treatment is added according to the grade of blood lead.

Because the metal complexing agent used in lead repellent therapy also has a certain complexation effect on other metal elements in the body, it is easy to cause the lack of essential trace elements in the child's body and needs to be supplemented in time.

Of course, the child's mother hopes that the child will get better soon.

So the second treatment option was chosen.

The patient has high blood pressure due to lead poisoning, and antihypertensive drugs need to be given at the same time as treatment, and the monitoring of iron, zinc, calcium, magnesium and other elements in the patient's blood is also strengthened during the treatment.

After a course of treatment, the patient's blood lead dropped to 170mg/L, after which Xiaoru was allowed to maintain monitoring and follow-up of the patient.

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