Back in 2002 as a doctor

Seeing Director Han's politeness to Zhou Congwen, Xiao Kai smiled slightly, feeling that he was walking much more steadfastly.

He has contacts with professors in many departments of the Second Hospital of Medical University. After coming to the provincial capital, Xiao Kai's main work goal at the beginning was to contact the medical resources in the provincial capital besides learning technology.

Anyway, he didn't need to write medical records, so Xiao Kai was able to contact experts and professors in many departments, and the relationship was pretty good.

From the experts and professors of the Second Hospital of the Medical University, they learned that the person they fear most is not the dean, but Director Han of the Medical Affairs Department.

Xiao Kai is familiar with all kinds of gossip about Director Han, and he clucks his tongue for it.

It's hard to describe Director Han's awesomeness, but he has a big background behind him, and even he was able to talk to the fourth master back then, and even the arrogant fourth master had to give some face.

Thinking of the fourth master back then, and looking at Director Han's attitude towards Zhou Congwen, Xiao Kai's balance tilted a little again.

Zhou Congwen first went to the ward to see the patient.

In the ward, a woman less than 30 years old sat on the edge of the bed crying silently with red eyes, and a man sat on the sofa dejectedly, full of frustration.

"Xiao Zhao, this is the Professor Zhou I told you about."

After entering the door, Director Han immediately introduced.

The man stood up immediately. Although he was a little surprised when he saw Zhou Congwen, he still managed his emotions well and did not lose his composure.

"Professor Zhou, thank you so much for being so late." The man reached out and shook Zhou Congwen's hand.

His hand was like a superficial touch, he touched Zhou Congwen and left.

"You're welcome, I'll take a look at the child."

Zhou Congwen didn't mind the man's attitude, but went directly to the bedside and rubbed his hands vigorously a few times to increase the temperature of the hands and avoid the child's discomfort.

Xiao Kai stood aside and watched silently. Zhou Congwen's physical examination was very thorough, but what was surprising was that there were no positive signs.

In the child's urine bag, the urine is very dark in color, and this kind of urine is clinically called soy sauce urine.

It seems wrong to say that there are no positive signs.

Based on clinical experience, Xiao Kai judged that the child's face seemed a little pale and his breathing was a little short.

But that doesn't mean much, as almost countless conditions can induce similar signs.

"It's nothing." Zhou Congwen smiled, "Who is more familiar with children's daily life?"

"Me." The woman replied, wiping away her tears.

"Come to the office and I'll ask you some relevant questions."

"Professor Zhou." The man stopped Zhou Congwen, and he said bluntly, "Can you help me contact 912?"

"Hehe." Zhou Congwen smiled lightly, "You have to take a look at the 912 first, or you will send it to the wrong department, and the experts there have a bad temper, and I can't stand it. It was reported in 912 that I don't know how to see a doctor. That would be boring."

The man touched a nail that was neither soft nor hard, and suddenly didn't know what to say.

What Zhou Congwen said seemed to be the case, but he felt strange, something was wrong.

"Let me ask first, to do a simple understanding, or report the situation with the 912 experts." Zhou Congwen added.

"Xiao Zhao, listen to Professor Zhou." Director Han said with a bit of sternness in his seriousness.

The two had a white face and the other a red face, and they cooperated tacitly. The man gave up his previous thoughts and nodded.

Coming to the office with the woman, Zhou Congwen said gently, "Sit down."

"Professor Zhou, isn't it?" the woman whispered after sitting down.

"Don't be so polite, let me ask a few questions." Zhou Congwen said, "When did the child's situation start?"

With that said, Director Han took the medical records handed over by the director of the high-ranking ward next to him, and handed them to Zhou Congwen.

Zhou Congwen read the test sheet and listened to the woman's statement.

The first time the child fell ill was about one and a half years old, and after that, he fell ill intermittently, and each time he went through certain treatments, he would get better.

When it’s good, it’s like a normal person. In addition to dark soy sauce urine after getting sick, there are several changes in liver and kidney function.

For example, this time, the liver and kidney function of the patient has changed greatly. Although it is not enough to diagnose acute liver and kidney failure, it is still on the edge.

"What do children usually like to eat?" Zhou Congwen asked.

"Soy milk, deep-fried dough sticks, KFC."

Oh, KFC has entered the domestic market.Zhou Congwen, who had already left the world of mortals, was slightly dazed when he heard the familiar name.

Go try it when you have time, it’s been a long time since I’ve eaten KFC.

"Did you eat any special food before getting sick this time?" Zhou Congwen asked.

Xiao Kai was taken aback.

What Zhou Congwen asked meant that he already had a diagnosis in his mind, and he didn't listen to the patient's family members talking about the incomplete past history like casting a net, but directly asked inductive questions.

Generally speaking, leading questions are taboo in asking medical history, but there are exceptions to everything.

Xiao Kai finds it incredible that the child has almost no positive signs, and now his liver and kidney functions are not good, and he still has soy sauce urine.

With just such a little information, Zhou Congwen already has his own judgment? !

"Eat...no." The woman shook her head firmly, and then talked about what the child ate recently.

She is obviously the one who usually takes care of the children more, and she is very familiar with the children's daily life.

"Then please ask the kindergarten teacher if you have seen any children bring broad beans to school." Zhou Congwen said lightly.

"broad bean?"

"Ah."

"I..." The woman looked at Zhou Congwen with surprised eyes, as if she was looking at an idiot.

"what happened?"

"I didn't let the child eat nuts since he was a child, for fear that he would choke. I also learned the Heimlich first aid method, but it has never been used." The woman said casually.

Zhou Congwen smiled.

It seems that this woman is quite interesting.

Heimlich's first aid method is a basic common sense after the Internet is popularized in the future. Many people learn it on the Internet and apply it in reality.

And the person in front of me has learned the Heimlich first aid method at the end of the 20th century, so he can be regarded as a genius.

To use Zhou Congwen's thinking, this woman's obsessive-compulsive disorder is simply too serious. Although it has not reached the point where it needs to be treated, it is almost the same.

But her narration blocked Zhou Congwen's path.

"If that's the case..." Zhou Congwen pondered, "Can I go to the house and have a look?"

"what?"

Director Han and Xiao Kai frowned at the same time.

Go home and take a look?Why?

Chapter 1010 Broad beans and camphor

"Go to my house? Why?" The woman was also taken aback.

"I highly suspect that the child is allergic to the environment." Zhou Congwen said in a flat tone.

The woman's eyes flickered, and the feeling of distrust grew stronger.

"Let's put it this way, I preliminarily diagnosed the child with glucose-6-phosphate dehydrogenase deficiency after a physical examination."

"..."

"..."

"..."

Everyone in the office was dumbfounded.

Glucose-6-phosphate dehydrogenase deficiency, what the hell is this!

Even the old clinics such as Xiao Kai and Director Han did not fully describe the full name of the disease.

"To put it simply, glucose-6-phosphate dehydrogenase deficiency is also called broad bean disease." Zhou Congwen continued, "Most of the time, this disease does not show up, and patients have no abnormal symptoms. But in After eating certain foods, such as broad beans, there will be an irritation reaction."

"Within 24 to 48 hours after exposure to broad beans, patients may show some specific symptoms - including pale complexion, shortness of breath, yellow skin, whites of eyes, soy sauce urine, etc. In severe cases, acute renal failure may occur."

"Zhou..." The woman was getting impatient, she looked at Zhou Congwen in disgust, "Professor Zhou, I said before, the child has never eaten broad beans!"

"I know." Zhou Congwen was not angry, but continued to say flatly and kindly, "Fava bean disease is just a common name, and some patients will have a similar hemolysis reaction after taking oxidative drugs due to the lack of enzymes in the body."

"Uh..." The woman was taken aback.

"Clinically, this is called drug-induced hemolytic anemia, of which more than 6% are caused by G-90-PD deficiency, and oxidative drug-induced anemia is when patients with G-6-PD deficiency take oxidative Acute hemolysis following an active drug."

"This type of drug mainly includes: primaquine antimalarial drugs, such as primaquine, quinine, etc.; antipyretic drugs, aspirin, angiopyrine, phenacetin, etc.; sulfa drugs, cotrimoxazole, etc. ; Sentinyl furans, furadantine, furazolidone, etc.; isoniazid, procarbazine, Padgett, vitamin K, etc.

Zhou Congwen mentioned more than a dozen kinds of medicines in succession.

The woman was taken aback by his words, and looked at Zhou Congwen in a daze.

At this time, if Huang Lao was sitting across from him, just the wrinkles on his face sculpted by time would be enough to make the patient's family believe in their judgment.

But Zhou Congwen can't.

His young and handsome face has no trace of age, and it is difficult to be convincing.

But even so, the detailed narrative seemed to make the patient's family believe Zhou Congwen a little bit silently.

"Professor Zhou, I'm sure the child hasn't taken any medicine recently." The woman said firmly.

It's embarrassing now... Xiao Kai's big toe was digging hard at the sole of the shoe, trying to dig out a three-bedroom and one living room.

"I'm just talking about one of the possibilities, and there's another possibility. Although it's rare, it's also the reason why I'm going home to take a look." Zhou Congwen didn't feel embarrassed, and the smile on his face was warm and friendly, as usual Wu Er, "Mothballs, do you use them at home?"

"..." The woman nodded blankly.

"A very small number of patients also experienced hemolytic reactions without taking broad beans and related products, and without oral oxidative drugs, because their physique is extremely sensitive to mothballs."

"Professor Zhou, the child will definitely not eat mothballs!" The woman's face was a little red, and she waved her arms to argue.

"I'm not talking about taking it orally, but that there will be a reaction when you smell it." Zhou Congwen said.

"Glucose-6-phosphate dehydrogenase, which exists in all cells, is also involved in the decomposition of glucose. In addition, it also protects red blood cells and has an antioxidant effect."

"Do you think it's inconceivable that mothballs have caused such serious problems in children?" Zhou Congwen asked.

The woman nodded blankly.

"That's because ordinary people rarely understand the mechanism of action of mothballs." Zhou Congwen said.

Xiao Kai scratched his head. Professor Zhou is really knowledgeable. An old clinician like him has never heard of favism disease.

But if it's just broad beans, Xiao Kai can still understand.

Clinically, I have seen many people have all kinds of weird allergies, and nut food allergies are very common.

However, Zhou Congwen mentioned mothballs after the patient's mother blocked all roads.

This time his mind was completely blank.

"The main ingredient in mothballs is naphthol, which is highly volatile.

Naphthol can enter the blood through the skin when people put on the clothes where the mothballs were placed.

There is glucose-6-phosphate dehydrogenase in the red blood cells of normal adults, which is the enzyme I just mentioned that eating broad beans is related.

This enzyme can quickly combine with volatile naphthol to form a non-toxic substance, which is excreted with urine, so naphthol will not have a significant impact on adults. "

"If you explain it this way, you can understand it." Zhou Congwen asked in a very understanding manner after finishing speaking.

The woman looked blank.

"Simply put, broad beans and their products, oxidative drugs, and camphor can all induce favism."

"If it's inconvenient to go home, you can recall whether your child has changed into new clothes before and after each illness," Zhou Congwen said.

The woman's hands trembled slightly, trying to brush her hair, but failed after several attempts.

Zhou Congwen was not surprised. The child was a typical fava bean disease, so it was logically logical to use the method of elimination.

Moreover, the expression and demeanor of the patient's family members have already explained the problem - their diagnosis is correct.

"Is there?" Zhou Congwen asked.