I can see health

Chapter 491 Ascension Again!

At this moment, the nurse hurried over again.

"Lu Chen, the old man who was just accepted by your group, his fingertip blood sugar is high again!"

"High again?" Lu Chen frowned, and the patient's fingertip blood sugar exceeded the measurement limit again.

"Didn't you already fill up so much fluid?"

Anyway, even if insulin is not used, the blood is diluted and the blood sugar will drop!
"okay, I get it."

Lu Chen immediately opened the patient's laboratory inquiry column.

此时，患者进入CCU急查的生化结果也回报了，肌酐459μmol/L、尿素55.41mmol/L、葡萄糖25.17mmol/L、血钾4.35mmol/L、血钠154mmol/L！

When Lu Chen saw this result, he was taken aback.

"Lu Chen, what's wrong?"

Seeing Lu Chen's abnormal expression, Gu Xinyue hurried over, and he also saw the test results on the computer.

"The patient's blood sugar and creatinine are so high?!" Gu Xinyue said, "Although the result is abnormal, there is no need to be so surprised, right?"

In the CCU ward, the creatinine and blood sugar of many patients exceeded this old man.

But Lu Chen said in a deep voice: "The result is just an appearance. From this biochemical sheet, we can see more things."

Gu Xinyue frowned, what else could be seen from an ordinary biochemical sheet.

他正在思索只是，就听陆晨继续道：“此时患者的有效血浆渗透压是（154+4.35）*2+25.17=342mOSM/L，已经明显超过了290-310 mOSM/L的界值。”

"If the effect of BUN is added, the plasma osmotic pressure has reached 397mOSM/L at this time!"

"397?" Gu Xinyue was startled, "This... such a high osmotic pressure?"

Lu Chen nodded slowly, and continued: "I just looked at the patient's examination results two days ago, and the plasma osmotic pressure had reached 336mOSM/L at that time. It was not much higher at the time, so it was not taken seriously."

Speaking of this, Gu Xinyue, as a top student at Jinghua Second Academy, immediately understood!
Gu Xinyue glanced at Lu Chen and said, "So, the rapid increase in osmotic pressure is the root cause of all the patient's clinical manifestations: mental changes, oliguria, hypovolemic shock, and acute kidney injury."

"That's right!" Lu Chen nodded slightly, "This patient doesn't have cerebrovascular disease, heart failure and kidney failure, but a typical type 2 diabetes with high blood sugar and hyperosmolarity!"

This also makes sense, why the trend of the patient's life value has always been three minus signs!

If the diagnosis is wrong, the corresponding treatment will be very different.

At this moment, Gu Xinyue suddenly realized.

"I need to tell Teacher Zhou Bin immediately, I'll go find her." Lu Chen said.

"Okay, I'll go with you." Gu Xinyue followed closely behind.

……

Zhou Bin is helping patients in other groups to do echocardiography.

In the entire CCU ward of Jinghua Second Hospital, Zhou Bin's Echocardiography is top-notch.

"The probe needs to be adjusted to an angle here. Look, can't you see it clearly?"

"Teacher Zhou's technique is really good. I just watched it for a long time, but I can only make a blurry image."

"Ultrasound, there is no special technique, practice makes perfect."

Zhou Bin smiled, but at this moment she thought of Lu Chen.

This is only a second-year graduate student, and her attainments in ultrasound have already surpassed her!
……

At this time, Lu Chen and Gu Xinyue rushed to Zhou Bin's side.

"Mr. Zhou, the biochemical results of the six-bed old man are out!" Lu Chen hurriedly said.

Seeing Lu Chen's anxious expression, Zhou Bin also felt that the patient's condition might be beyond everyone's development.

She put down the echocardiography probe and asked quickly, "What's wrong?"

Lu Chen directly handed over a test sheet, "I just calculated the osmotic pressure, it is at least 397!"

"The osmotic pressure is so high?" Zhou Bin took the test sheet, got up immediately, and walked towards the doctor's office, "Could it be the hyperosmolar state of diabetes?"

As expected of a senior attending doctor, Zhou Bin reacted immediately, and directly hit the key point - hyperosmolar state of diabetes.

"I think so!" Lu Chen nodded.

Diabetic hyperosmolar state is common in type 60 diabetic elderly over 2 years old.

Most of the triggers are infection, acute gastroenteritis, pancreatitis, cerebrovascular accident, insufficient water intake, and large intake of sugary drinks.

This patient happened to have one thing, that is, he consumed a lot of sugary drinks.

Due to the gradual increase in osmotic pressure, central nervous system symptoms appeared, manifested as limb weakness, convulsions and development of coma, and hypovolemic shock.

……

Go back to the doctor's office.

Zhou Bin took out all the examinations and tests of the patient.

Doctors from other groups gathered together as long as they were free.

Zhou Bin said slowly: "Actually, we went back and analyzed this patient. From the inducement to the clinical manifestations to the laboratory examination, they all conform to a very typical state of hyperglycemia and hyperosmolarity."

Lu Chen nodded and echoed, "However, due to our solidified clinical thinking, we preconceived the patient as acute exacerbation of chronic heart failure and cardiorenal syndrome."

"Ignored the markedly elevated blood glucose and mildly elevated plasma osmolality early on."

"In the initial treatment, a large amount of hypertonic fluid was added to the patient, and a large amount of diuretics were used, which not only missed the best time to correct the hyperglycemia and hypertonicity, but also contributed to the disease."

The stubborn "three minus signs" on the old man's life value is the best proof.

Preconceived ideas often make patients' treatment go to extremes.

This old man first went to the Eighth District of Heart.

In the Department of Cardiology, I naturally think of the diseases in my own department, such as heart failure, cardiogenic shock and so on.

However, the real cause of the patient is often hidden in the depths.

Without a broad clinical thinking ability, it is impossible to get the final correct answer.

On the contrary, patients will delay the opportunity of treatment because of narrow diagnosis.

……

Just when Lu Chen finished speaking, a prompt popped up on the system panel.

"Congratulations, the clinical thinking ability has improved!"

A simple reminder without any notes.

Lu Chen also received this reminder after participating in a difficult case discussion in his heart.

However, there is no detailed explanation of what effect it has and how much the ability has been improved.

However, Lu Chen also relaxed his mind, something is better than nothing!

……

Now, the diagnosis is clear.

The next step is to adjust the treatment measures.

In the state of hyperglycemia and hyperosmolarity in diabetes, the key to treatment is to quickly replenish the body fluid and electrolytes lost due to osmotic diuresis and reduce osmotic pressure.

"Continue to replenish fluids." Zhou Bin said.

The word rehydration is easy to say.

But how to supplement and what to supplement is a big problem.

What's more, the patient has a long-term history of chronic heart failure, and large doses of fluid replacement are likely to cause acute heart failure.

Without rehydration, the osmotic pressure cannot be reduced, and the cause of the disease cannot be solved.

This big problem was once again in front of everyone.

(End of this chapter)