I Can See Health

   Chapter 491 Boosts again!

   At this moment, the nurse hurried over again.

   "Lu Chen, the old man your group just received, the blood sugar at his fingertips is high again!"

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

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

   After all, even if you don't use insulin, your blood will be diluted and your blood sugar will drop!

"okay, I get it."

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

   At this time, the biochemical results of the patient's emergency examination in the CCU were also reported, creatinine 459μmol/L, urea 55.41mmol/L, glucose 25.17mmol/L, blood potassium 4.35mmol/L, blood sodium 154mmol/L!

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

   "Lu Chen, what's wrong?"

  Gu Xinyue saw that Lu Chen's expression was abnormal, so he hurriedly came 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 results are abnormal, there is no need to be so surprised, right?"

   In the CCU ward, there are many patients whose creatinine and blood sugar exceed this old man.

  Lu Chen said solemnly: "The result is just an appearance. From this biochemical list, we can see more things."

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

   He was just thinking about it when he heard Lu Chen continue: "At this time, the patient's effective plasma osmotic pressure is (154+4.35)*2+25.17=342mOSM/L, which has clearly exceeded the threshold of 290-310mOSM/L."

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

   "397?" Gu Xinyue was shocked, "Is this... such a high osmotic pressure?"

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

   Having said that, as a scholar-level figure of the Second Academy of Jinghua, Gu Xinyue immediately understood!

  Gu Xinyue glanced at Lu Chen and said, "So, the rapid increase in osmotic pressure is the root cause of all the clinical manifestations of the patient: altered consciousness, oliguria, hypovolemic shock, and acute kidney injury."

   "That's right!" Lu Chen nodded slightly, "What is this patient with cerebrovascular disease, heart failure and renal failure, but a typical type 2 diabetes hyperglycemia and hyperosmolar state!"

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

   The diagnosis is wrong, and the corresponding treatment varies greatly.

   At this moment, Gu Xinyue suddenly realized.

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

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

  …

   Zhou Bin is helping other groups of patients with heart ultrasound.

   In the entire CCU ward of Jinghua Second Hospital, Zhou Bin's echocardiography technique is considered to be first-class.

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

   "Mr. Zhou's technique is really good. I just watched it for a long time, and I could only make a blurry image."

   "There are no special skills for ultrasound, practice makes perfect."

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

   This is just a second grade student, and her ultrasound attainments 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 6-bed uncle have come out!" Lu Chen said quickly.

  Looking at Lu Chen's anxious look, Zhou Bin also felt that the patient's condition may have exceeded everyone's development.

   She put down the heart ultrasound probe and said quickly, "What's wrong?"

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

   "Is the osmotic pressure so high?" Zhou Bin took the test sheet, got up immediately, and walked towards the doctor's office, "Is it a diabetic hyperosmolar state?"

  Zhou Bin is worthy of being a senior attending doctor, he reacted immediately and directly hit the key point-diabetic hyperosmolar state.

   "I think so!" Lu Chen nodded.

   Diabetic hyperosmolar state, common in elderly people with type 2 diabetes over the age of 60.

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

   This patient has exactly one point, that is, a large amount of sugar-sweetened beverages.

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

  …

   Back to the doctor's office.

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

  The doctors from the other groups, as long as they were free, came over.

   Zhou Bin said slowly: "Actually, we went back and analyzed this patient. From the incentives to clinical manifestations to laboratory tests, they all conform to a very typical hyperglycemic hyperosmolar state."

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

   "Early markedly elevated blood glucose and mildly elevated plasma osmolality were ignored."

   "Supplementing a large amount of hypertonic fluid and using a large amount of diuretics for the patient during initial treatment not only missed the best time for correction of hyperglycemia and hyperosmolarity, but also contributed to the disease."

   The stubborn "three minuses" on the old man's health is the best proof.

   Preconceived ideas often lead to extremes in the treatment of patients.

   This old man first went to the eight districts of the heart.

   Cardiology department, naturally think of the diseases of its own department, such as heart failure, cardiogenic shock and so on.

   However, the real cause of the patient is often hidden deep.

   Without 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.

  …

   When Lu Chen finished saying these words, a prompt popped up on the system panel.

   "Congratulations, clinical thinking ability has improved!"

   A simple reminder without any remarks.

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

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

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

  …

   At present, the diagnosis is clear.

  The next step is to adjust the treatment measures.

  Diabetes with hyperglycemia and hyperosmolar state, the key to treatment is to quickly replenish body fluids and electrolytes lost due to osmotic diuresis and reduce osmotic pressure.

   "Continue to add fluids." Zhou Bin said.

  The word rehydration is easy to say.

   But how to make up and what to make up is a big problem.

   What's more, the patient has a long history of chronic heart failure, and high-dose fluid replacement is likely to cause the onset of acute heart failure.

   No fluid replacement, and no way to reduce osmotic pressure, can't solve the cause.

   This big problem is straddled in front of everyone.

   (end of this chapter)