Chapter 521 The last question, the truth is revealed!

When everyone was puzzled, Xu Qiu didn't hold back and said bluntly: "The problem lies in the patient's personality.

“He was yelling during several ward rounds.

“This was in the presence of several of our doctors, so he restrained himself a little.

"And last night, the doctor went to the duty room, and the nurse was waiting at the nurse's desk to be called. There were only three of them in the ward, so he probably cursed a lot.

"The condition improved slightly, but before his respiratory function had fully returned to normal, he started shouting loudly. With his character, he would continue to show off his strength even if he was suffocated to death... Therefore, respiratory alkalosis was finally caused."

This explanation would seem far-fetched to any patient.

However, when thinking of Wei Ding, all the doctors present thought, "This is definitely the case"...

This patient is really capable of such a thing.

No, that's not right. It should be said that he does this kind of thing every day.

"That should be it, but how to explain such a critical condition?" Director Shen still couldn't figure it out.

Xu Qiu said: "Two reasons.

“First, the patient has a history of chronic anemia, which will aggravate myocardial ischemia.

"Second, once respiratory alkalosis occurs, myocardial ischemia will reach an extreme. Combined with the increased risk of cardiovascular risk caused by sibutramine, the patient will suffer from acute heart failure."

Xu Qiu also discovered this during his physical examination last night. Jugular vein distension and other symptoms are symptoms of right heart failure.

If he hadn't noticed this, he wouldn't have thought about cardiovascular disease, let alone sibutramine, a once popular but now banned drug.

In the interlocking process, Xu Qiu finally revealed the truth.

Xu Qiu continued to explain: "As for why it is so serious, the reason is heart failure.

“Respiratory alkalosis worsens the situation of the already ischemic myocardium, and the occurrence of acute heart failure prompts the patient to hold his breath, which leads to an aggravation of the patient’s acid-base imbalance and fatal hypoxia.

This further aggravates respiratory alkalosis and causes metabolic acidosis in the body.

Immediately afterwards, the degree of myocardial ischemia continued to deepen..."

After Xu Qiu finished speaking, everyone's expressions were a little dull. In this vicious cycle of rapid development, it would be difficult for gods to save them.

Who would have thought that Xu Qiu could seize hemoglobin from countless critical values, take blood replenishment as the primary treatment measure, accurately cut off the chain of aggravation of myocardial ischemia, and completely interrupt the vicious cycle...

"Oh My God!"

“Only now do I realize that if we had not desperately replenished blood, added hemoglobin, or used any other treatment, the patient might have died from worsening circulation!”

"Dr. Xu didn't even know the cause of the disease at that time, but he knew the most reasonable way to rescue him. How on earth did he do this!"

After everyone figured out the progress of the patient's disease, they were shocked and their admiration for Xu Qiu doubled.

He Hai, Wang Fan and others who participated in the rescue at that time were frightened for a while.

Without Xu Qiu rushing back to the rescue, they might have been working for several hours, but the patient would still be dead!

Respiratory alkalosis - aggravation of myocardial ischemia - heart failure leading to breathlessness - further aggravation of respiratory alkalosis and metabolic acidosis - myocardial ischemia becomes more serious...

This is an almost unsolvable pathogenic chain that leads directly to death.

But within a few minutes after Xu Qiu arrived at the scene, relying only on clinical intuition, he eliminated other equally critical interference items, and used the knife of "blood replenishment" to stop the vicious cycle at the point of "myocardial ischemia". .

…

"Is this still an early shift? The discussion of model cases in the province is nothing more than this." Wang Ping looked at Xu Qiu, and he felt a shameful feeling of worship in his heart.

Doctors in the emergency department are honored.

Look, this is the standard of early handover in our department.

"So that's it..."

"No wonder the disease progresses so quickly and cannot be controlled at all. It is because every link is gradually getting worse!"

"This patient is finally solved, it's not easy!"

Everyone was filled with emotion.

Just when his face was about to look relaxed, Director Shen suddenly frowned: "No, this is the explanation for the rapid deterioration of the condition.

"But why did it get better so quickly?"

This cannot be solved by blood transfusion. Relying on blood transfusion can only curb the progression of the disease and slowly restore body functions.

But the patient was fine in just over half an hour and could even get out of bed and walk.

Moreover, his liver function almost reached the normal target. Half an hour ago, his transaminase level was in the thousands, dozens of times higher than the standard!

Everyone was in high spirits, thinking that the medical record was finally over, but when they heard Director Shen's words, they suddenly realized that there were still doubts that had not been solved.

Director Lin thought for a while and added: "Speaking of liver function, various literatures do not mention the hepatotoxicity of sibutramine, let alone cause acute liver injury. Even if the patient takes a large amount of sibutramine for a long time, resulting in It’s also chronic liver damage…”

Xu Qiu said: "Who said the patient had acute liver injury?"

"Isn't it..." Everyone was stunned.

Even Wang Ping, He Hai and others showed shocked expressions.

Such an exaggerated liver function damage indicator is not acute liver injury, what else could it be?

They originally thought that this was the undoubted truth and an obvious fact, but Xu Qiu's words made everyone begin to doubt their clinical thinking.

Xu Qiu shook his head and said, "No, our direction is not wrong. The sharp increase of transaminase is also an indicator of acute liver damage."

Wang Ping immediately said, "Then what do you say..."

"Because it is not only acute liver damage that can cause liver damage."

This is a bit confusing.

Take the most sensitive liver function test indicator, alanine aminotransferase, for example.

The concentration of alanine aminotransferase in normal people's blood is very low. Only when liver cells are damaged or the permeability of liver cell membranes increases, the enzyme in liver cells is released into the blood, which will cause the concentration of alanine aminotransferase in serum to rise rapidly, indicating liver damage.

But, these two reasons are not the only ones that can cause the index to rise.

Xu Qiu gave the answer: "The patient is not suffering from acute liver damage in the conventional sense, but...congested liver!"

Congested liver?

Director Shen, Director Lin, Wang Ping and others looked at each other, their pupils suddenly contracted, and it seemed that a thunderbolt sounded in their minds.

At this moment, the directors felt that they were suddenly enlightened.

The disease that had troubled them for a long time was presented to them so clearly for the first time.

From the initial onset of the disease, to the subsequent acute deterioration, to the last near-death experience last night, everything was explained!

"Bloody liver? What's going on?" Several neurologists looked confused.

They were also very anxious. The director seemed to understand, but they were still confused!