Back in 2002 as a doctor

"In this regard, consider a diagnosis of sulfhydryl-containing drugs that may induce insulin autoimmune syndrome."

Drugs containing sulfhydryl groups may induce insulin autoimmune syndrome?

Whether it was Teng Fei or other circulatory doctors, they all looked confused.

"There are some sulfur-containing drugs in clinical practice, and captopril is one of them." Zhou Congwen said, "So when using captopril, we must closely observe it to avoid similar situations."

After Zhou Congwen finished speaking, he looked around.

"Professor Zhou, you said that the hypoglycemia was caused by taking captopril?" A circulatory physician questioned, "It's not in the instructions."

Teng Fei had already believed it, because she knew very well how powerful Zhou Congwen was.

Zhou Congwen put on the posture of leading the students, so she shouldn't talk nonsense, so she believed it without thinking.But when he heard the doctor's question, Teng Fei suddenly realized that there was no such side effect in the instructions.

Chapter 1379 The Man Who Can Recite Drug Instructions

"The lack of hypoglycemia in the drug instructions does not mean that captopril does not have this problem." Zhou Congwen said.

The doctor in the circulatory department seemed to curl his lips, but he restrained his expression and questioning abruptly, and tried his best to lower his head.

Zhou Congwen wasn't in the limelight, he had wiped enough buttocks for the circulatory department, even if he said something insignificant, the circulatory doctor knew that he had to endure it no matter what.

Looking at the expression of the circulatory physician, Zhou Congwen smiled.

"I know the instructions." Zhou Congwen said.

The circulatory physician's expression showed disbelief.

"First, it is contraindicated for patients who are allergic to this product and have decreased leukocytes."

"Second, it should be used with caution in patients with renal insufficiency, elderly patients, pregnant women and lactating mothers."

"third……"

"tenth……"

"No.13, if proteinuria gradually increases while using this product, suspend this product or reduce the dosage."

Zhou Congwen immediately began to recite the instructions.

As he said each and every side effect, the atmosphere in Xiaoshi's classroom became extremely delicate.

All previous doubts vanished.

It's not that Professor Zhou Congwen Zhou didn't understand, let alone didn't know, he could recite it one by one, and even said that he could recite it backwards like a fluent, and everyone in the room believed it.

Physicians usually focus on medication, but who can recite drug instructions?

If someone can memorize the drug instructions, then the hypoglycemia he said is probably true.

"The drug instructions are just the result of the research under the historical conditions at that time, and we can't confine ourselves to it." Zhou Congwen looked at the circulatory physician and smiled, "The main reason why I want to sit down with you and talk about it is For the side effects of captopril."

"The label is the result of the research at that time, and now captopril has some other off-label uses. For example, the treatment of ascites due to cirrhosis."

"Ah? Liver cirrhosis and ascites?" Teng Fei was taken aback.

"The renin in most patients with cirrhosis and ascites? Vascular tension-aldosterone system is often more active. The increase of vascular tension can cause renal artery constriction, which may be one of the disease mechanisms of hepatorenal syndrome. Captopril is selective Vascular dilating effect, after using the drug, while the systemic arterial pressure decreases, the hepatic blood flow also decreases."

"!!!"

"!!!"

Everyone was astonished.

"Besides, captopril can treat Raynaud's disease."

"Uh……"

"In addition to inhibiting the production of angiotensin II, its mechanism of action is also related to the participation of bradykinin. Due to the reduction of angiotensin II and the increase of bradykinin, the blood vessels dilate and the resistance of peripheral blood vessels decreases, which improves the quality of the fingers and toes. Microcirculation in other places."

Zhou Congwen stood in front of the blackboard and talked eloquently, and Shen Lang gradually became a little confused.

Is this the real gossip spirit that Zhou Congwen said?

However, the various usages of captopril seem to be meaningless, how can the gossip in the emergency department be so refreshing, Shen Lang thought to himself.

"So, the principles of a drug's use are changing from research and development to clinical use. It's like sildenafil citrate..."

When Zhou Congwen said this, he immediately stopped.

This kind of thing can't be said too much. I have already got a nickname of "outside" in 912. Always mentioning sildenafil citrate will make people think that there is something wrong with me.

"Now, let's talk about it." Zhou Congwen tapped on the blackboard, not giving everyone in the room a chance to think about whether they have "off-site" problems, and continued, "Insulin autoimmune syndrome is one of the causes of organic hypoglycemia. .”

"About half of these patients have incentives, and careful examination of the medical history often reveals that patients have often used sulfhydryl-containing drugs."

"And captopril happens to be one of the drugs that contain thiols."

"Professor Zhou, what are the mercapto drugs?" Teng Fei no longer doubted, but asked for advice humbly.

"Antithyroid drugs such as methimazole, antihypertensive drugs captopril, hepatoprotective drugs glutathione and tiopronin, antibiotics such as imipenem, penicillamine and β-lactamase antibiotics, and endocrine Branches for the treatment of diabetic neuropathy drugs а-lipoic acid, etc."

"In the ICU, the patient's blood sugar is not stable. After excluding other possibilities, we should pay attention to whether the patient has used imipenem, penicillamine and β-lactamase antibiotics."

"In daily life, hypoglycemia coma occurs frequently, and it is necessary to consider whether glutathione is used."

"There was once a patient whose blood sugar was not stable and fluctuated violently in severe illness." Zhou Congwen started his own gossip. When he said this, he gave Shen Lang a deep look.

Shen Lang listened with pricked ears.

"Blood sugar fluctuated violently, no matter how hard I searched, I couldn't find an answer. In the end, I searched the entire imperial capital for consultation. My boss went to check the medication, and finally confirmed that it was caused by Jingdian Taineng."

Taineng, also known as imipenem cilastatin sodium for injection, is the most advanced antibiotic commonly used in clinical practice.

And it actually has such side effects, Zhou Congwen's explanation stunned the doctors in the circulatory department.

Director Han listened carefully, his small eyes kept turning, as if thinking about something.

Zhou Congwen talked for 10 minutes before stopping.

"The thiol-containing drug can reduce the disulfide bond of insulin to make it cleaved, change the structure of endogenous insulin, lead to the exposure of some self-antigens, be recognized by specific major histocompatibility complex molecules and trigger specific T cell cloning proliferate, leading to the production of insulin autoantibodies."

"Similar reactions are not very common, and captopril is not impossible to use. If captopril is stopped because of a rare hypoglycemia, it will be a waste of food because of choking."

"What I mean is that, as a department that commonly uses this type of drug, it is necessary to understand the side effects of the drug. Once a patient has similar problems in the future, it is not necessary to say that it has nothing to do with me, which is ridiculous."

Yixiao is generous, these four words really make sense, Director Han smiled slightly.

Professor Zhou Congwen Zhou is the generous one.

"Okay, that's it." Zhou Congwen clapped his hands, "Director Han, it depends on your opinion on what to do next. I think it's more appropriate to admit the patient to the hospital."

"Okay, Professor Zhou, you've made it so clear, I don't dare to let the patient go." Director Han said with a smile, "Here, he will be admitted to the hospital, and the hospital will bear the expenses. You can't just admit to doing something wrong."

Fujifi sighed.

Zhou Congwen confused her, she really didn't expect that there are so many things about a commonly used medicine.

Defeat yourself with what you are best at... Such a thought suddenly appeared in Teng Fei's mind.

But I have nothing to say, people can recite the drug instructions, what can I use to refute.

Chapter 1380 Dalang takes medicine

Zhou Congwen turned everyone's head covering, but he didn't think about clinical medicine at all, Director Han, who only thought about the relationship between doctors and patients, remained sober.

"Okay, Professor Zhou, I'll take care of the next thing." Director Han respectfully sent Zhou Congwen out of the classroom.

He finally understood why Zhou Congwen was so trustworthy this time.

It should be in the office of the academician workstation. Zhou Congwen had a guess when he heard the conversation between himself and the staff.

And going to the emergency department to see a patient just proves guesswork.Facts have proved that Professor Zhou's guess is correct, as stable as ever.

Thinking of this, Director Han's mood is a bit complicated, it takes a lot of clinical experience to make so many judgments after listening to a few small talk.

……

Zhou Congwen didn't know what Director Han was feeling, he, Xiao Kai, and Shen Lang left the Circulatory Medicine Department.

"Congwen, you said that since sulfur-based drugs have side effects, can you not use them?" Shen Lang asked thoughtfully.

"What are you talking about?" Zhou Congwen said contemptuously, "Containing sulfur is basically a useful chemical..."

As he said that, Zhou Congwen smiled slightly. Shen Lang would definitely doze off after listening to the chemical formula, so saying it was equivalent to not saying anything.

"Let me tell you a gossip."

"!!!" Shen Lang immediately cheered up.

"For example, glutathione is a tripeptide containing a γ-amide bond and a sulfhydryl group. It is composed of glutamic acid, cysteine ​​and glycine and exists in almost every cell in the body."

"Didn't you say you want to gossip?" Shen Lang asked listlessly.

What Zhou Congwen said was not what Shen Lang wanted to hear at all.

"Didn't I tell you about the background?" Zhou Congwen smiled, "Otherwise you don't know anything, and your basic common sense is so weak that you wouldn't understand me even if I told you."

Xiao Kai felt that Zhou Congwen was yin and yang to himself.

Xiao Kai himself didn't understand anything about the things just now.Is the basic clinical knowledge weak?

I have always thought that I am a top student who graduated from a top prestigious school. Xiao Kai has always said that others have a weak foundation. I never thought it would fall on me today.

Alas, who is as strong as Professor Zhou.

"This substance is also involved in oxidation-reduction reactions, so health care companies have begun to notice this. You know, women and children earn the best money. Stay young forever, nothing else, just these four Do you think the nurses in our department will buy it with bright eyes?"

"Yes! Absolutely!!" Shen Lang said with certainty.

"So, various types of glutathione will be encountered frequently in the future." Zhou Congwen said, "But as I just said, glutathione contains sulfur groups, which may lead to abnormal insulin secretion, followed by hypoglycemia."

"Oh, that's it."

After Shen Lang heard a plausible gossip, he completely forgot the question he had asked before, and chased after Zhou Congwen and asked, "Wouldn't it be bad if some people reacted?"

"Yes, remember the compound licorice tablets I told you about?"

"When did you tell me?" Shen Lang asked suspiciously.

Zhou Congwen was taken aback, his thoughts spread out in an instant, and he tried to find the problem.

Zhou Congwen himself couldn't remember what happened to such a trivial matter.He felt that the only possibility was that Shen Lang had talked a lot of gossip while Shen Lang was in hibernation, among which the gossip about licorice was said at this time.

But it doesn't matter, Zhou Congwen has a thick skin and is a stinky hooligan, so he doesn't care at all.

"There was once a patient with inexplicable hypoglycemia. He was very young. When he was delivered, he was already dying. A large amount of sputum blocked the airway."

"Later, the boss thought it might be caused by eating glutathione, and his wife did it on purpose."

Shen Lang's eyes were round and round.

Zhou Congwen told Shen Lang about licorice and the gossip about Da Lang taking medicine, turning Shen Lang's attention to an unknown direction.

After talking about the invisible killing method of licorice poisoning, Zhou Congwen smiled, "Everything has advantages and disadvantages. This is the dialectical method of materialism. Because there are no side effects? Why are you so big?"

"Hey." Shen Lang didn't refute Zhou Congwen's words, just heard Zhou Congwen's big gossip, Shen Lang seemed to eat a piece of candy, still thinking about it.

"Let me tell you another gossip." Zhou Congwen was not in a hurry, and said while walking slowly, "A young man carefully prepared a charcoal hot pot to cook the pickled fish that girls like most."

"As a result, the confession was rejected by the girl. By the way, Shen Lang, are you still chasing Manager Wang?" Zhou Congwen was talking, and suddenly remembered last year that Shen Lang coveted Wang Xueteng's beauty, so he asked.

"No, it's boring." Shen Lang said, "I don't understand the girl's mind, let alone Manager Wang's kind of high-cold, what about the nurses in our department, what they say is completely different from what they think in their hearts."

"Don't guess what the girl is thinking. You can't figure it out after guessing. This is fun, you know nothing!" Zhou Congwen reprimanded.

"How do you..."

"I have a girlfriend." Zhou Congwen said seriously.

At this time Liu Xiaobie is very useful, moving her out can stop many people's mouths.

Shen Lang scratched his head, what Zhou Congwen said seemed to be true, but he always felt something was wrong.

"Where did I go?" Zhou Congwen asked.

"I prepared a charcoal hot pot, confessed my love, and was rejected. Do you want to talk about carbon monoxide poisoning caused by insufficient charcoal burning?"

"No." Zhou Congwen smiled slightly, "If it's so easy to guess, is it still called gossip?"

"Oh?" Shen Lang became interested.

"The young man failed to confess, and drank at home. It was boring to be alone. At this time, he called a friend, and this action saved his life."