I Can See Health

   Chapter 82 Is my face black?

   After asking the nurse, I learned that the new patient is in bed 12.

  Lu Chen walked quickly to the ward where the 12th bed was.

   At this time, it was already nine o'clock in the evening.

   It was pitch black outside, and the ward was brightly lit.

   She pushed the electrocardiograph to bed 12.

   A 16- or 17-year-old girl was lying on the bed, half lying on the bed, her expression was indifferent and her spirit was extremely lethargic.

  Lu Chen looked at the HP above her head, it was 51 in red!

   Another patient with less than 60 health!

  …

   saw Lu Chen walk into the ward.

  Min Ling turned her head and said, "Did you send the patient to the ICU safely?"

   "Yes." Lu Chen nodded.

  The patient was delivered safely, but I don’t know how long it will last.

   "Well, very good." Min Ling nodded, "Then come and see this patient, ask for the medical history, review the electrocardiogram, and then go back and write about the course of the disease."

   "Received." Lu Chen nodded.

After   Min Ling finished speaking, she went back to the doctor's office.

  …

  Beside the hospital bed, there was a middle-aged man in his forties, who should be the girl's father.

   "Classmate, do you feel uncomfortable?"

  Lu Chen walked to the hospital bed and asked softly.

   The girl didn't answer, she was still lying on the bed, turned over and turned her back to Lu Chen.

   Lu Chen was most afraid of meeting such a 16- or 17-year-old girl.

   is in the rebellious period of youth, and it is difficult to communicate deeply.

   The middle-aged man on the side said solemnly: "Doctor, my daughter has been feeling dizzy and weak recently. These symptoms have worsened tonight, her limbs are weak, and she can't even walk, so she hurried to the hospital."

   Dizziness, fatigue?

   Weak limbs?

   "Did you do any examinations in the outpatient clinic?" Lu Chen frowned.

   "Done." The middle-aged man took out two laboratory tests.

  Lu Chen reached out and took it.

  The first one is the blood routine, and there is nothing abnormal.

   The second picture is a biochemical series, with normal liver and kidney functions.

   But in the electrolyte, potassium ions are only 2.1mmol/L.

   This is severe hypokalemia!

  Potassium is the primary cation that maintains cellular physiology and is essential for the proper functioning of nerve and muscle cells, including cardiomyocytes.

   Under normal circumstances, the blood potassium (potassium ion in the blood) concentration is 3.5~5.5mmol/L.

  When serum potassium is less than 3.5mmol/L, the human body may show weakness, anorexia, nausea, abdominal distension, and in severe cases, unpredictable risk factors such as dyspnea, arrhythmia, and even sudden death may occur.

   No wonder girls feel dizzy, weak, and weak in their limbs.

   Potassium ions are so low, it would be strange if you had the strength.

   But why is potassium ion so low?

  Lu Chen frowned.

   Generally speaking, there are three reasons for low potassium.

   First, too little intake; second, too much excretion (gastrointestinal tract, kidney); third, metastatic distribution.

   "How is her appetite recently?" Lu Chen asked.

   "It's okay, it's about the same size as before."

  The amount of food has not changed, which means that it should not be the first reason, and the intake is too small.

   "Any symptoms of nausea and vomiting?" Lu Chen continued to ask.

"No."

   also ruled out excessive losses from the gastrointestinal tract.

  If you want to rule out other reasons, you can only rely on further tests and inspections.

  Lu Chen wanted to give the girl a simple physical examination, but she was more resistant and gave up.

  Looking at her like this, she couldn't do an electrocardiogram either.

  Lu Chen had to give up.

   "Family, come out with me."

   In front of a girl, there are many questions that are difficult to ask.

  The middle-aged man followed Lu Chen to the corner of the corridor.

   "Has her character always been like this?" Lu Chen asked suspiciously.

  Although he is in a period of rebellious age, he is not so resistant to the doctor's consultation and examination.

   "It used to be fine, but for the past six months, hey..."

   The middle-aged man shook his head slightly, then sighed.

   "Having entered a period of rebellious youth?" Lu Chen asked in confusion.

   "Yeah, and it's more serious and prone to depression." The middle-aged man said, "Take her to see a psychiatrist, who was diagnosed with moderate depression."

depression?

  Lu Chen also sighed slightly in his heart.

   Such a beautiful girl has depression.

   is like a clear sky for thousands of miles, suddenly there are dark clouds, and you don’t know when it will clear up.

   "She has symptoms of dizziness and fatigue. How long has it been?"

   "Half a year."

   "It's been half a year..." A trace of doubt flashed in Lu Chen's eyes.

   Is it chronic hypokalemia?

   "Did you take any special food or medicine?"

   The middle-aged man was stunned for a moment, recalled, and then shook his head.

   Lu Chen asked some details again, and the middle-aged men responded one by one.

  …

   Back to the doctor's office.

  Min Ling has completed all the patient's medical orders.

   "Well, come back, what kind of disease do you think it is?"

  Lu Chen sat next to Min Ling, paused for a while, then said.

   "The cause of hypokalemia is yet to be investigated. As for the cause, there is no clue yet. In addition, the patient has moderate depression."

  Min Ling nodded.

   "The patient was admitted to a lower-level hospital two months ago, and hypokalemia was also diagnosed at that time, but no cause was found."

   "After a while, her family will bring the medical records over. After reading it, let's write the course of the disease."

   "Okay." Lu Chen nodded.

   Hypokalemia has been diagnosed before, which will definitely improve the examination related to hypokalemia.

   "For the time being, treat the symptoms first and make up the potassium." Min Ling said, "I asked her to drink three pots of potassium chloride first, and then intravenous potassium supplementation at the same time."

   As for potassium supplementation measures, Lu Chen has studied in the internship, but he is not professional.

   He clicked on the doctor's order system and carefully checked the doctor's order issued by Min Ling.

   "Mr. Min, is the first choice for potassium supplementation in clinical practice?"

   Lu Chen wondered.

"Well, intravenous potassium supplementation has speed and concentration limitations." Min Lingdao, "Oral potassium supplementation, direct oral potassium chloride oral solution or injection, there are not many restrictions, but there are some gastrointestinal stimulating effects, usually we all Dilute with juice and milk."

  Lu Chen took notes while listening to Min Ling's explanation.

  Good memory is not as good as bad writing.

   There are many things in clinical practice that are not in internal medicine books.

   Such as potassium supplementation.

   In clinical practice, "potassium chloride injection" is often taken orally, which is the most effective way to supplement potassium, but there is no hint in the internal medicine book.

   "Little Lu, which department are you a graduate student?" Min Ling asked suddenly.

  Lu Chen was taken aback for a moment, and then replied: "In my heart."

   "Oh, in my heart." Min Ling nodded, "No wonder you just met such a critical patient, so you didn't panic, you've seen it a lot. How many times did you study this year?"

  Cardiology department is the most critical department in all internal medicine departments. Patients may change their expressions at any time, and the risk of sudden death is extremely high.

   "Research one." Lu Chen said.

   "Only the first one?" Min Ling glanced at Lu Chen in surprise, "I thought you were studying the second or third."

   Seeing Lu Chen's unhurried handling of the patient's condition, Min Ling also felt that he should have stayed in the clinic for a long time.

   I didn’t expect to be a freshman.

   "By the way, which endocrinology teacher's group are you in? Why haven't I seen you?" Min Ling wondered.

  Lu Chen touched his nose, "Teacher, I work the night shift for a friend, he can't come for something."

   "Oh, no wonder I always feel like I haven't seen you in the department. You haven't rotated to endocrinology yet, have you?"

"No."

   "Then it's time for endocrinology, so you can come to our group."

  Lu Chen was taken aback for a moment, isn't the group divided by the teaching secret?

   "Don't want to?"

   "No, yes." Lu Chen nodded quickly.

   "That's fine." Min Ling smiled slightly.

   She is the teaching secretary of the Department of Endocrinology.

   Having met such a good seedling ahead of time, of course she has to stay in her own group, so that she can relax a lot in peacetime.

   For these attending physicians, there are no resident physicians in the department, so having a graduate student or graduate student who is handy will be of great help!

  Lu Chen hasn't come to the endocrinology department yet, but he has already been booked!

  …

   "ding ding..."

   The phone vibrated suddenly, and Lu Chen received Zhou Wei's WeChat.

   "Is the night shift in the endocrinology department okay? Are you already sleeping?"

  Lu Chen remembered that it was Zhou Wei who said that the endocrine night shift is good.

   He quickly replied to a WeChat message.

   "You said that the night shift in the endocrinology department is good?"

   Lying on the bed, Zhou Wei, who was about to sleep, raised his brows when he received the reply letter, Lu Chen is not asleep yet?

   "Yes, I worked three night shifts, and each night shift was almost safe. Once a patient had hypoglycemia, let him eat a candy, and that's fine."

   "But I have already pushed a patient to the ICU, and a very serious patient has come..."

"That's your face!" Zhou Wei smiled, and then quickly replied to a WeChat message, "There are four endocrine districts, and each district accepts patients in turn. Originally, there are very few patients on night shifts, so the chance of accepting patients is very low. low."

  Lu Chen's brows furrowed into a word "Chuan", is it my face?

   Thank you for the reward of the full moon every night, whether the Three Kingdoms, 2020083.

   (end of this chapter)