I can see the status bar

Chapter 677 Diabetes (September 9th, 27th update)
Although he really wanted to help, Sun Lien was just an emergency physician after all.He can influence and control very little about the affairs on the other side of the ocean—not even as good as Xu Yourong herself, who has lived in the United States for several years.

Although Sun Lien himself had the idea of ​​helping, self-knowledge was obviously more important than this idea.Xu Yourong has just arrived in the United States, her lover has been locked up in a mental hospital and tortured, and now her mind is probably full of lawsuits.In this case, it is obviously not a smart move to keep calling and asking about the situation.

Sun Li'en sighed countless times today.But he still restrained his emotions.Although a place like a hospital is where science and technology occupy the main guiding factors, the emotions of doctors are actually equally important.Even if a confident doctor and a dejected doctor prescribe the same treatment plan, sometimes the effect on the patient will be a little different - especially when the patient is keenly aware of the doctor's lack of confidence when.

Since it is a job, you have to be worthy of your responsibilities.Sun Li'en rubbed his face, stood up and prepared to complete the final ward round.Wang Ge's condition has improved, but he is still a long way from being discharged from the hospital.His personality seems to have begun to change to a certain extent, at least now he is not as frequent as before.

"Doctor Sun, I'm looking for you." Just as he walked out of the office, Professor Zhang stopped Sun Lien.Professor Zhang Zhifu walked over with his legs crossed, patted Sun Lien's arm happily and said, "I just got a call, and Dean Liu told me to go to the ICU to see if there are any patients that need to be diagnosed."

The Department of Critical Care Medicine of the Fourth Hospital is basically the busiest department in the entire hospital except for the Department of Pediatrics and the Emergency Department.Thanks to the CCU, PICU and other intensive care units are directly managed by the cardiology and pediatrics, otherwise the doctors in the intensive care unit would have died on the spot in protest.

Earn a few more departments to generate income?If it doesn't exist, no matter how fragrant the money is, you have to spend it.

From the perspective of intensive care physicians, their attitudes towards Sun Lien and the Comprehensive Diagnostic Center are very complicated.On the one hand, Sun Li'en and the Comprehensive Diagnostic Center have taken many actions in the past to find the cause of the patients in time and stabilize their condition.As for the patients who have stabilized, except for a small number of patients who can be directly admitted to the comprehensive diagnosis center for hospitalization or transferred to other specialized inpatient departments, the rest are all stuffed into the ICU.

In the past year, the workload of the ICU has increased by at least 12% year-on-year, and these books are all thanks to Sun Lien.

Although they hated a lot of work in their hearts, the doctors in the ICU also had to admit that all the patients sent by Sun Li'en and the diagnosis center were clearly diagnosed.They don't even need to do additional tests, just follow the advice of the diagnostic center.

Therefore, the attitude of the entire intensive care medicine department to the comprehensive diagnostic center is very inconsistent.Most of the inpatients and attending doctors think that the diagnosis center is in the way, while those above the resident general have a good impression of the diagnosis center-diagnosis in the field of intensive care medicine is also a very important part.In many cases, after identifying the cause, doctors in the intensive care department can even start targeted treatment before the disease develops further.This "one step ahead" treatment model has greatly increased the survival probability of the patients who were transferred.

But not all patients who stay in the ICU can enjoy this "one step ahead" treatment.Although the emergency department of the Fourth Hospital is strong, it is only an emergency department after all.Not many patients are able to obtain a complete and accurate diagnosis in the emergency department.Especially when the patient's life is obviously in danger, the requirements for diagnosis in the emergency department should naturally be relaxed a little more—unless it is a monster like Sun Lien who can make a diagnosis while rescuing, other emergency doctors will first treat the critically ill patients first. Once the patient's condition stabilizes, a preliminary diagnosis is made based on the current information, and finally the patient is sent to the ICU.

After completing other examinations in the ICU, patients with stable vital signs and a basically clear diagnosis will be sent to the corresponding specialist for further hospitalization.

As a result, in the ICU, there are many patients who need to be diagnosed every day, and the general illness is not mild.In the past, it was almost impossible to completely cover these patients who needed to be diagnosed with only one Sun Lien team.But now with Professor Zhang's team, the Department of Critical Care Medicine suddenly became energetic.Before Professor Zhang Zhifu took the initiative to contact them, the Department of Critical Care Medicine found Liu Tangchun, "Director Liu, can you invite Professor Zhang to come to us for a diagnosis?"

There are several troublesome patients in the ICU.Especially a diabetic patient who has been in the ICU for three days is particularly troublesome.

"Diabetes? Is it a ketosis coma?" Sun Lien and Professor Zhang Zhifu sat together in the small office of the Department of Critical Care Medicine and looked at the materials.Sun Li'en originally planned to keep silent the whole time, but just came over to show his face.But Sun Lien couldn't help it when he heard that the most troublesome patient in the critical care medicine department was actually a diabetic.

Most people with diabetes can be classified into two categories - type [-] diabetes or type [-] diabetes.People with type [-] diabetes have symptoms of high blood sugar because the pancreas does not produce enough insulin.People with type [-] diabetes, on the other hand, mostly have symptoms of insulin resistance, where their bodies don't respond well to insulin.Therefore, although enough insulin is produced, the blood sugar level in the body still does not go down.

And when the blood sugar content is kept at a very high level, the human body will have serious metabolic disorders.This metabolic disorder will cause the body to fail to use the glucose in the blood normally for energy, thus switching to fat consumption.

Fat first needs to be converted into ketone bodies before the body can turn to use it.But when ketone bodies are produced too much and exceed the level that the tissue can use, the patient will appear ketoneemia and ketonuria.The most direct consequence of the accumulation of ketones is diabetic ketoacidosis.

Ketoacidosis is a common emergency in internal medicine, but... from Sun Lien's point of view, it is far from the point where it needs to be diagnosed.Ketosis has very clear indications. The random blood sugar level is greater than 16.7mmol/L, the blood ketone body is greater than 4mmol/L, and the patient is accompanied by clear symptoms such as unconsciousness and decreased plasma carbon dioxide binding capacity.

Although ketoacidosis is an emergency and could even be called a serious condition, its diagnosis is not difficult.No matter how much he thought about it, Sun Lien couldn't understand why the ICU regarded this patient as a case that "needs a diagnostic center".

"It's not acidosis." Sun Li'en's doubts were quickly answered to a certain extent, "This is a hyperosmolar coma patient."

The full name of hyperosmolar coma is "hyperosmolar nonketotic diabetic coma". As the name suggests, it is a nonketotic coma caused by diabetes.The patient is mainly due to the aggravation of glucose metabolism disorder, which leads to hypertonic state of extracellular fluid, which leads to hypovolemic hypertonic dehydration.And this kind of dehydration is manifested in the patient, which becomes "coma".

"The patient is 29 years old, and his family members said that the patient had obvious polyphony and polyuria in the past two years, and he drank more than 2000ml of water per day." Wu Faxian, director of the Department of Critical Care Medicine, told Sun Li'en and Professor Zhang, "And this is a serious lover of Coca-Cola. He drank at least three bottles of Coke a day. Since his weight has been dropping for two years, his family did not think there was any problem with his body."

Drinking cola generally makes people gain weight, which is the main reason why many people love and hate carbonated drinks.But what is more terrifying than gaining weight is the situation of "drinking a lot of Coke every day, but losing weight instead".Generally speaking, this means that the patient has a high probability of suffering from diabetes - excessive drinking and urination, and weight loss under the condition of excessive eating, which are the main early signs of diabetes.

"Good guy... 1000ml per day." Professor Zhang was also shocked by this data, but he quickly focused on other content, "29 years old, a bit early."

"We also suspected that it might be type 12 diabetes, but the patient's condition did not support this judgment." Director Wu continued, "At 30 o'clock in the morning on the day he was admitted to the hospital, his family members found him lethargic, but he could answer simple questions. And at 120:79.42 noon 6.98, then began to respond, restlessness and shortness of breath. The family members of the patient handed in 2, and the blood sugar was checked in the emergency department.

Good guy... Sun Lien was taken aback by this statistic.With such a high blood sugar, the patient's blood might taste sweet.

"The emergency department gave him a CT scan, which indicated the possibility of multiple lung infections, pulmonary edema, and cerebral edema." Director Wu continued, "The emergency department received 8000ml of crystalloid fluid, and the urine output was 3000ml. 160 units of insulin were used. , the blood sugar dropped to 22mmol/L. At the same time, cephalosporins were also given to convergent anti-infection, and 5% sodium bicarbonate was used in a total of 375ml."

From this string of numbers, Sun Lien could vaguely see what the emergency department looked like at that time. 5% sodium bicarbonate is the first-line clinical drug for the treatment of metabolic acidosis.However, the dosage of this injection is generally not too large-it is usually packaged in 10ml or 20ml ampoules.

I used 375ml in one breath... Sun Lien adjusted his sitting posture, feeling a little sympathetic to the nurse who was in charge of dispensing the medicine at that time.

"After we took the person up, we checked the blood sugar again, and it was 22.8mmol/L. We refilled 3500ml of fluid again, and continued to use insulin. At the same time, we also used meropenem to fight infection. At 2:80 in the morning today, the patient appeared cyanotic. The SPO[-] dropped to [-]% and we intubated him."

Professor Zhang's face was as heavy as water, and after a moment of silence, he nodded lightly and said, "I'll take this patient."

Sun Li'en was silent thoughtfully at the side, other aspects were easy to talk about, but from Director Wu's introduction, he still vaguely felt a little awkward.This awkwardness mainly comes from the physical reaction of this "blood may taste sweet" patient.

The blood sugar content is 79.98mmol/L, which sounds scary.But Sun Lien felt that what was more terrifying was yet to come.

胰岛素是一种非常强力的降糖物质，一个单位的胰岛素大概能够中和3克葡萄糖。葡萄糖的分子量是180，而一个正常人的血容量大概是4.2~4.8升。也就是说，一个单位的胰岛素大概能够降低3.47~3.96mmol/L的血糖。

And this patient...he was given 160 units of insulin in the emergency department alone. If calculated according to this ratio, with such a huge dosage, as long as the patient's blood sugar level is not higher than 555mmol/L, fatal hypoglycemia may occur.

But not only did he not have hypoglycemia, even after supplementing with 8000ml of fluid, his blood sugar was still as high as 22.8mmol... This insulin resistance is too serious.

　The diarrhea is basically gone, but the stomach pain... still occasionally, the lingering pain occasionally, it is really annoying.

　　However, it is much better than before, and Sanguan is now gradually recovering, first to make changes every day, and then to increase the amount.

　　I don’t know if you have any travel plans on October [-], but Luo’s trip is definitely going to be ruined—stay at home for eight days and continue to nourish your stomach...

　　
　
(End of this chapter)