After 100 Days Of Sign-In, The First Operation Shocked The World

"...Uh, no, I only checked blood and potassium levels at the beginning..."

"Let's check... blood magnesium and blood potassium together..."

Lin Feng began to explain: "Although you have already supplemented sodium, the renal tubules need sodium-potassium pumps to reabsorb potassium, and sodium-potassium pumps require magnesium ions. Therefore, if hypomagnesemia and hypokalemia are combined, magnesium should be supplemented first, otherwise it is simply Potassium supplementation is not effective..."

The gastroenterologist nodded in agreement: "Dr. Lin is right... the blood potassium and blood magnesium need to be reviewed..."

"in addition,"

Lin Feng paused: "There is another possibility..."Guillain-Barré syndrome" (Chapters 351-353)..."

Explained what is "Guillain-Barré Syndrome".

When Dr. Wang Zhen heard it, he slapped his head with chagrin, "Why didn't I expect this...I'm so stupid!"

He hurriedly asked the patient’s family: “Did the patient have a cold, fever, upper respiratory tract infection, or where it was inflamed, or had it been vaccinated in the most recent “170”?

Why do you ask?

Because "Guillan Barre syndrome" is an autoimmune disease, usually there is a history of infection or vaccination before the onset.

(Ps: Book friends, if you experience general weakness after the vaccination, you may need to pay attention to whether it has caused "Guillain Barre Syndrome"!)

result,

The patient's family members have none of these! !

However, despite the patient's family saying so, it is still necessary to check whether it is "Guillain-Barré syndrome."

Next, there is no need for Lin Feng to say more.

·Check blood potassium, blood magnesium...

·Check if it is "Guillain-Barré syndrome": cerebrospinal fluid, etc...

Lin Feng finished working,

Return to the emergency department...

...

Half an hour later,

The Department of Neurology called and responded to the results of the examination:

· Hypomagnesium + hyperkalemia (continuous potassium supplementation)!

At this time, regardless of whether the patient's current condition is "hypomagnesium," magnesium supplementation is reasonable and necessary.

2 hours later,

The patient was supplemented with magnesium ions. After one and a half hours, the patient's condition has been relieved a lot, his limbs have been weakened, and he can speak...

Now, it can be determined:

"Low blood magnesium"!

...

...

result,

The drama happened.

At 11 o'clock,

Zhang Zhen encountered another patient with general weakness, soreness, and hypokalemia.

This patient is quite special, and is different from the previous patient with magnesium deficiency and potassium deficiency, the "Guillain-Barré syndrome".

·Patient, Zhang Aidi, female, 62 years old,

The specific situation is:

Main complaint: weakness of limbs for one month

·Medical history: none

When Lin Feng saw this, his first reaction was the weakness of the limbs caused by "hypokalemia."

Then through questioning, she found that she had no appetite for a while, not eating much, and the old lady was relatively obese.

In this case, the first reaction is ketoacidosis.

Eat less food -> not enough sugar to break down -> consume fat -> produce a lot of keto acid -> ketoacidosis.

So, I pierced my finger to the old lady, and the blood sugar was very low.

Therefore, ketoacidosis may have occurred.

However, Lin Feng’s first consideration was "hypoglycemia" rather than "hypokalemia" for the patient's old lady's illness at this time.

Because of low blood sugar, it can also cause weakness.

then,

Let the old lady drink glucose first to replenish blood sugar.

Half an hour later,

The blood sugar has recovered, but the limbs are still weak.

Lin Feng ruled out "hypoglycemia" causing weakness in limbs, and reconsidered "hypokalemia".

So, check as follows:

·Check "hypokalemia" related items

·Check items related to "ketoacidosis"

·Urine routine...

...

noon,

Lin Feng finished his meal and returned to the emergency department.

"Doctor Lin, the result came out..."

The old lady's son handed the result to Lin Feng.

Lin Feng looked at the inspection results:

· Determine hypokalemia.

· Determine ketoacidosis (mild).

·Urine routine: Although there are no white blood cells and protein, the pH value is 7.5 (alkaline), which is alkaline urine (normally between 5.0 and 6.5, which is acidic)

Obviously, this is "hypokalemia + ketoacidosis."

As for the third urine routine, why is it alkaline urine?

It's simple!

Because of ketoacidosis!

One of the criteria for determining ketoacidosis is the concentration of bicarbonate, mild bicarbonate 15mmol/L; moderate bicarbonate 10mmol/L; severe bicarbonate 5mmol/L,

The patient is ketoacidosis, so the body lacks enough "bicarbonate" 0 ........

Hydrogen ions are reduced, so potassium ions have to replace it with sodium ions to exchange potassium ions, resulting in increased excretion of potassium from the kidneys. Urine can be measured as the acid decreases and the urine pH naturally rises. Therefore, urine is alkaline and is called "abnormal alkali." Sexual urine".

At this moment,

The old lady said, "Dr. Lin, I have a little bit of soreness all over my body recently. Is it also related to this disease?"

Lin Feng nodded: "It is indeed possible..."

The logic is:

Because of acidosis——>inducing osteolysis, and inhibiting the reabsorption of calcium by renal tubules——>causing osteoporosis...

This may not feel much in the body of young people, after all, young people have strong bones.

But the elderly are different. The elderly themselves are a bit osteoporotic.

Add up,

It becomes ‘serious’.

That's why the patient's old lady is sore all over.

"Wait, I'll prescribe some medicine for you..."

Ketoacidosis has been resolved by drinking glucose.

What about hypokalemia?

Lin Feng prescribed "potassium citrate" to the patient's old lady!

(Ps: Potassium citrate is not available in small hospitals. Only the more advanced provincial hospitals will have 2.3 available...)

Why not open the most classic "potassium chloride"?

After all, potassium chloride is cheaper, and the commonly used potassium supplement is ‘hard vegetables’.

Why do you want to prescribe the medicine "potassium citrate"?

There are reasons for this:

The old lady itself lacks bicarbonate. If we supplement the patient with "potassium chloride", the chloride ions will increase, the concentration of bicarbonate will further decrease (combined), and acidosis will be aggravated!

At this time, the potassium in the cell will be transported to the outside of the cell, and then excreted through the kidneys, aggravating the loss of potassium.

Supplementing potassium chloride at this time will not only not increase potassium ions, but will make potassium ions-the more supplemented, the lower!

The best way is to supplement "potassium citrate"!

——————————

ps: The latter case is a bit complicated...

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