Doctor: It's reasonable to perform surgery on yourself.

The lactic acid produced by the human body is first metabolized into pyruvate in the liver, and then converted into glucose through gluconeogenesis.

If there is a problem with the liver and it cannot be cleared in time, lactic acid will accumulate in the muscles, resulting in lactic acidosis, leading to metabolic acidosis.

In addition to lactic acid metabolism, there is another common cause of acidosis, which is ketone body production.

The decomposition and metabolism of fat in liver tissue will produce ketoacids, which will produce hydrogen ions during decomposition and be excreted from the body through the small intestine.

The production of ketoacids is a feedback process. When the body is in an acidic environment, the production of ketoacids decreases. On the contrary, when it is in an alkaline environment, the production of ketoacids increases.

Under normal circumstances, the mechanism of liver production of ketoacids has very little effect on acid-base balance.

However, if the body is starved for a long time or under the premise of alcohol poisoning, the human body cannot break down sugars and can only break down fat to produce energy, thus generating a large amount of ketoacids, causing severe acidosis.

This is also called ketoacidosis, which is a very common acute and severe disease.

But neither of these two can explain Ding Tao's symptoms.

Although the lactate in the patient's examination was high, it definitely could not cause such severe acidosis, so it can basically be ruled out.

As for liver ketosis...

The patient did not eat breakfast, but it was only short-term hunger, and the body did not rely on a large amount of fat decomposition to provide energy.

Furthermore, if it is so serious, it must be ketoacidosis, and the manifestation of ketoacidosis is extremely typical.

The first is the smell - the patient's breath smells like rotten apples.

But Ding Tao did not have it.

Secondly, ketoacidosis has a characteristic triad.

Hyperglycemia, increased anion gap metabolic acidosis, and ketonemia.

The first item of high blood sugar alone is enough to rule it out - the patient's blood sugar is within the normal range, and there is no history of diabetes at all!

...

Then, there is only the second causal relationship.

Acidosis causes acute liver damage!

However, this possibility is even lower.

Respiratory acidosis can be ruled out first. It is a series of poisoning symptoms caused by decreased pulmonary ventilation function and respiratory diseases caused by various reasons, which leads to an increase in the storage of carbon dioxide in the body, and generally does not cause liver damage.

Ding Tao is suffering from metabolic acidosis.

Even so, it is impossible to cause liver damage in the short term. The only possibility is long-term metabolic acidosis, but in that case, chronic liver damage occurs, not acute liver damage!

…

"So it seems that only acute liver damage can cause acidosis?"

After analyzing for a while, Xu Qiu found that he was back to square one.

But it was not without gain, at least the diagnostic target was found.

Chronic anemia and acidosis are both interference factors.

Let's start with acute liver damage!

In acute liver damage, albumin homeostasis and urea production have little effect on acid-base balance and cannot cause such amazing acidosis.

Only excessive lactic acid production and excessive liver ketone production are left, which are the only two possible directions.

Among them, excessive lactic acid production is the most intuitive indicator of lactic acid in blood routine. Xu Qiu has already done an examination, and the lactic acid is 27.1 units.

Normal people are between 0.5 and 1.7, and Ding Tao is almost fifteen times more, but this cannot support acidosis that is enough to cause death!

"So, there is a problem in the liver's ketosis stage, ketoacidosis?"

Xu Qiu was a little unsure.

Ketoacidosis is an acute and severe disease, and it is easy to cause a life-threatening pH value.

But the patient did not smell like a rotten apple, and his blood sugar was normal, which did not meet the three characteristic triads, and was not quite in line with it.

Xu Qiu rubbed his swollen temples, and had no choice but to arrange another ward round.

At the same time, new medical instructions were also issued.

Another routine blood test and blood sugar test were performed.

…

"Doctor Xu."

"Director Xu!"

In the ICU, Director Jiang, who had just finished the operation, came to greet him in person and accompanied him to Ding Tao's bed.

Director Jiang said: "The condition has stabilized for the time being, and there is no problem saving his life."

It's just... the cost is burning money.

The family members spend more than 10,000 yuan a day.

Xu Qiu was also in a hurry.

If the disease is not controlled soon, the family members' money is one thing, and the cost of saving the patient will also become higher and higher.

If she delayed further, her life could be saved, but the sequelae could not be avoided.

Ding Tao entered the intensive care unit with a heavy heart. At this time, she was completely different from when she was first admitted to the hospital.

Although she was pale at the beginning, it can be seen that she had a good living condition before she became ill, her skin was shiny, and her hair was fine, which could not be concealed by her pale face.

But in the past few days in the ICU, Ding Tao became a real patient.

Her eye sockets were sunken, her skin was dry, and her hair was dull and yellow. At the age of 27, her face was comparable to that of a middle-aged or elderly person in his 50s.

Her dull eyes could not see any vitality. Only when Xu Qiu spoke, her eyes could make a little reaction, moving woodenly twice, but soon fell silent again.

Ten minutes later, Xu Qiu left the intensive care unit.

This time, the physical examination still did not find any clues.

He found the family members waiting outside and asked about the patient's living conditions at home.

Still nothing.

Just as he was about to leave, he suddenly remembered ketoacidosis.

Although it seemed unlikely, the patient's lifestyle made him think of it in this way.

Xu Qiu paused and asked again: "Does the patient often skip meals?"

The family member's voice also lost the tension when he was just admitted to the hospital, and nodded silently.

He added: "Sometimes she eats one lunch, sometimes she eats two meals in the morning and evening, but the amount is not large... Doctor, when do you think my wife can be discharged from the hospital?"

He knew that the condition was serious, but he couldn't ask the question "Is there any hope?"

Xu Qiu raised his voice and said: "Don't worry, the hospital has been trying its best to treat her, and we will give the most professional rescue plan."

After that, he asked again: "Does she feel uncomfortable on weekdays?"

"Uncomfortable?"

Ding Tao's husband muttered, saying: "It seems that she does. She always says that she has no strength. She doesn't eat much, so how can she have strength."

Xu Qiu narrowed his eyes.

Fatigue?

Whether it is fatigue caused by abnormal tissue metabolism or a normal physiological manifestation of hunger is debatable.

He quickly asked: "What about other symptoms? Think about it carefully!"

Ding Tao's husband was reluctant to think deeply. When he thought of every little thing with his wife and thought about the present, his heart ached unbearably.

But he still recalled it carefully several times and said, "It seems that there was. She often pressed her chest and said that she felt uncomfortable."

"Uncomfortable, what kind of discomfort?" Xu Qiu's eyes lit up slightly, as if he had found a breakthrough.

"Sometimes she said it hurt, and sometimes she said it was stuffy."

Ding Tao's husband paused, and suddenly said, "By the way, something else happened at that time."

——

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