Chapter 769 Normal blood sugar? A rare case!
"What?" Xu Qiu looked over.
"She retched several times, and I was worried that she was pregnant again. But then I tested it and found that she was not." At this point, Ding Tao's husband lowered his head.
The young couple couldn't wait to reclaim the wasteland just after the pregnancy. This matter was originally unspeakable, but seeing that his wife's condition was getting worse, he dared not hide it anymore.
What if it was related to this matter, wouldn't it delay treatment?
Seeing Xu Qiu's frown getting deeper and deeper, Ding Tao's husband was a little panicked and said, "Doctor, is it really because of this?"
Xu Qiu shook his head: "No."
Fatigue, chest pain, chest tightness, and now vomiting... This has nothing to do with sex, but it perfectly fits the performance of mild acidosis.
Could it be... The patient already had similar symptoms?
Xu Qiu thought for a moment and asked, "When did these uncomfortable symptoms you mentioned begin to appear?"
Ding Tao's husband was obviously much more relaxed and said, "After giving birth."
"What about dieting?"
"Also... also after giving birth."
Ding Tao's husband's face changed slightly: "Could it be related to her not eating?"
Xu Qiu did not give a direct answer, but he already had a guess in his mind.
He hurried back to the office and opened CNKI.
If I remember correctly, Xu Qiu had seen a paper while browsing the literature, which recorded exactly the rare manifestation of ketoacidosis!
He tried to enter a few keywords.
Ketoacidosis;
Normal blood sugar;
Pregnancy or postpartum;
Seeing the first paper with the highest matching degree, Xu Qiu's eyes lit up.
"That's it."
He quickly opened the paper page and browsed it quickly.
…
《Progress in the diagnosis and treatment of diabetic ketoacidosis with “normal” blood sugar during pregnancy》
“Ketoacidosis is an acute complication of diabetes…”
“Due to a series of special physiological changes during pregnancy and the inherent insulin deficiency of diabetics, pregnant women are susceptible to diabetic ketoacidosis with “normal” blood sugar…”
“Different from ketoacidosis caused by severe insulin deficiency, the dehydration of normal blood sugar ketoacidosis is not obvious, and there is continuous urinary glucose loss, which makes it more susceptible to the disease in a ‘hungry’ state…”
…
Xu Qiu read it line by line, and his mind suddenly became clear.
General ketoacidosis is diabetic ketoacidosis. Complications of the disease, blood sugar will rise sharply, but for the special period of pregnant women and postpartum women, there is a special manifestation -
Ketoacidosis with normal blood sugar!
During pregnancy and postpartum, patients need to continue to fight against glucose starvation and insulin deficiency, so even a short fasting may lead to severe normal blood sugar ketoacidosis, which develops much faster than ordinary ketoacidosis.
The characteristic is one: the metabolic disorder is very serious, but the blood sugar abnormality cannot be found clinically, the initial symptoms are atypical, and once it occurs, it is severe acidosis!
"Yes, that's it! "
Ding Tao's situation is a perfect match.
He flipped through the pages again.
The headache is that although the paper reveals a corner of normal blood sugar ketoacidosis, it does not provide more specific treatment methods.
In fact, the international community does not have a special guideline for the treatment of normal blood sugar ketoacidosis during pregnancy and postpartum.
Xu Qiu fell into deep thought.
He needs to formulate a reasonable treatment plan!
"Simulated operating room..." With a thought, Xu Qiu entered the simulation space in his mind.
"As for the treatment measures, it is nothing more than the routine application of insulin, fluid replacement, correction of electrolyte disorders, etc.
"The patient's blood sugar is normal, and the urine sugar is also normal, so it is best to adjust the diet at the same time, increase the amount of water intake, reduce the production of ketone bodies, and accelerate the excretion of the ketone bodies that have been produced!"
This is considered a conventional treatment plan.
But after thinking about it, Xu Qiu crossed out the last few sentences.
Reducing ketone bodies by drinking water is not feasible!
General ketoacidosis patients can use this simple and crude method, but... Ding Tao has chronic anemia and mild heart failure.
As the amount of water consumed increases, the heart's load increases, and the burden on the patient's body will also be heavier.
"The condition can only be controlled by adjusting the dosage of drugs such as insulin!"
Xu Qiu immediately began to think about the medication plan.
Two hours later.
He opened his eyes again, called up Ding Tao's medical records, and issued medical orders on them.
"Insulin infusion..."
"The initial rate is 0.1U/kg*h.
"For fluid infusion, choose 10% glucose solution.
"Add 1U insulin for every four grams of glucose until the ketone bodies produced by the liver disappear.
"Infuse 600ml of fluid within two hours, and then adjust the rate to 50ml per hour..."
Insulin and fluid infusion, these two steps are tailored for Ding Tao.
Like ordinary people's fluid infusion, generally 1000ml of glucose solution is infused within two hours, but Ding Tao has the underlying disease of heart failure, and the amount of fluid intravenous infusion should not be too large, so Xu Qiu reduced it as appropriate.
"Alkali supplementation is also recommended."
In clinical practice, acid is preferred over alkali. In principle, alkali supplementation is very cautious. Generally, alkali supplementation is only given when the pH is lower than 7.20, the carbon dioxide binding capacity is less than 10 units, and the bicarbonate is less than 10 units. The standard is very high.
But Ding Tao's acidosis is already extremely serious, and the pH is also terribly low, which must be corrected quickly.
“5% NaHCO3 100 mL, 0.9% saline 400 mL, rate 200 mL/h, intravenous drip…”
…
There is one last item, potassium supplement.
Ding Tao’s blood potassium is also within the critical value.
Insulin treatment must be based on a blood potassium level of more than 3.5.
Only after the blood potassium level is raised can insulin infusion be started.
“Oral potassium supplement, 4 grams per day, try it for three days.”
…
Soon, a complete and impeccable treatment plan was released.
The nurse station immediately received the signal, and after seeing the new doctor’s order, they quickly notified the ICU’s ward doctor.
Seeing that the signature was Xu Qiu, the ICU people who were worried about Ding Tao were in a very good mood, and quickly started the new treatment according to the above dosage.
Three days later, Ding Tao was officially out of danger and a series of life support devices were removed.
Two days later, Ding Tao was officially transferred from the intensive care unit to the general ward.
Seeing that Ding Tao's condition was getting better and better, and that she would soon meet the criteria for discharge, the doctors in the clinic were extremely shocked.
There were constant "Wow" sounds in the group.
"Is this ketoacidosis? Is it really ketoacidosis?!"
"Isn't this disease related to diabetes? There are even normal blood sugar types..."
"Doctor Xu posted a document... My God, this document was seen by Xu Qiu, his reading volume is too scary!"
"This is the purpose of reading the literature. It doesn't require you to memorize the conclusions or the content. It is enough as long as you can remember that you have seen it in a certain paper when you encounter similar patients in the clinic in the future!"
