bookpower Chapter 533
Chapter 533
“...... Well, no, at the beginning, I only checked the blood and potassium..."
"Check it up... Blood magnesium and blood potassium check together..."
Lin Feng began to explain: "Although you have supplemented sodium, but because the renal tubular reabsorption of potassium requires a sodium-potassium pump, and the sodium-potassium pump needs magnesium ion assistance, so hypomagnesemia combined with hypokalemia should be supplemented with magnesium first, otherwise potassium supplementation alone is ineffective..."
The gastroenterologist nodded in agreement: "Dr. Lin is right... Need to review blood potassium, blood magnesium..."
"In addition,"
Lin Feng paused: "There is another possibility...'Guillain-Barré syndrome' (chapters 351-353)..."
Explain what "Guillain-Barré syndrome" is.
When Dr. Wang Zhen heard this, he patted his head in annoyance: "Why didn't I expect this stubble... I'm stupid! "
He quickly asked the patient's family: "Has the patient had a cold and fever, an upper respiratory tract infection, or inflammation anywhere, or has he been vaccinated?" "
Why do you ask that?
Because Guillain Barré syndrome is an autoimmune disease, there is usually a history of infection or vaccination before the onset.
(ps: Book friends, if after vaccination, there are symptoms of general weakness, you may want to pay attention to whether it has caused "Guillain Barré syndrome"!) ）
outcome
The patient's family has none of this!!
However, despite what the patient's family said, it is still necessary to check whether it is "Guillain-Barré syndrome".
Next, there is no need for Lin Feng to say more.
Check blood potassium, blood magnesium...
Check if it is "Guillain-Barré syndrome": cerebrospinal fluid, etc...
Lin Feng finished work,
Back to the emergency department...
......
Half an hour later,
The neurology department called and replied to the test results:
Low blood magnesium + high blood potassium (continuous potassium supplementation)!
At this time, regardless of whether the patient's current condition is "low blood magnesium", magnesium supplementation is reasonable and necessary.
After 2 hours,
The patient supplemented magnesium ions, and after an hour and a half, the patient's condition has been relieved a lot, the weakness of the limbs has been reduced, and he can speak...
At this point, it can already be determined:
"Low blood magnesium"!
......
......
outcome
The dramatic thing happened.
At 11 o'clock,
Zhang Zhen encountered another patient with general weakness, soreness, and low blood potassium.
This patient is more special, different from the previous patient who is unable to supplement potassium with magnesium deficiency, "Guillain-Barré syndrome".
Patient, Zhang Aidi, female, 62 years old,
The specifics are:
Complaint: Weakness in the limbs for one month
Medical history: none
When Lin Feng saw this, his first reaction was the weakness of his limbs caused by "hypokalemia".
Then through inquiry, I found that in recent times, she has no appetite, does not eat much, and the old lady is relatively obese.
In this case, the first reaction is ketoacidosis.
Eating less — > not having enough sugar to break down — > consuming fat — > producing a lot of ketoacids – > ketoacidosis.
So, I pricked my finger to the old lady, and my blood sugar was very low.
So, ketoacidosis may have occurred.
However, the patient's old lady's illness at this time, Lin Feng's first consideration became "hypoglycemia", not "hypokalemia".
Because of low blood sugar, it can also cause symptoms of weakness.
thereupon
Let the old lady drink glucose first to replenish blood sugar.
Half an hour later,
The blood sugar has returned, but the limbs are still weak.
Lin Feng ruled out "hypoglycemia" caused by limb weakness and reconsidered "hypokalemia".
So, check as follows:
Check for items related to "low blood potassium"
Check items related to ketoacidosis
Urinalysis...
......
midday
Lin Feng finished eating and returned to the emergency department.
"Doctor Lin, the results are out..."
The son of the old lady handed the result to Lin Feng.
Lin Feng looked at the inspection results:
Determine hypokalemia.
Determine ketoacidosis (mild).
Urinalysis: Although there are no white blood cells and proteins, the pH value is 7.5 (alkaline), which belongs to alkaline urine (normal people are generally between 5.0~6.5, which is acidic)
Obviously, this is "hypokalemia + ketoacidosis".
As for the third urinalysis, why alkaline urine?
Very simple!
Because of ketoacidosis!
One of the criteria for determining ketoacidosis is the concentration of bicarbonate, mild bicarbonate 15mmol/L; moderate bicarbonate 10mmol/L; severe bicarbonate 5mmol/L,
The patient is ketoacidosis, so the body lacks enough "bicarbonate".
Hydrogen ions decrease, so potassium ions have to replace it to exchange with sodium ions, resulting in increased potassium excretion from the kidneys, and the pH value of urine naturally rises after the acid is reduced in urine, so the urine is alkaline, which is called "paradoxical alkaline urine".
At this time,
The old lady said: "Doctor Lin, I have been a little sore all over my body recently, is it also related to this disease?" "
Lin Feng nodded: "It is indeed possible..."
The logic is:
Because acidosis – > triggers osteolysis while inhibiting the reabsorption of calcium by the renal tubules – > can cause osteoporosis...
This may not feel much in the young man's body, after all, the young man has strong bones.
But the old man is different, and the old man itself is a little osteoporosis.
Add
It becomes 'serious'.
That's why the patient's old lady is sore.
"Wait a minute, I'll prescribe you some medicine..."
Ketoacidosis, which has been solved by drinking glucose.
And what about low blood potassium?
Lin Feng prescribed "potassium citrate" to the patient's old lady!
(ps: The drug potassium citrate is not available in small hospitals, only more advanced provincial large hospitals will have it... ）
Why not open the most classic "potassium chloride"?
After all, potassium chloride is cheaper, commonly used potassium supplementation 'hard dish'.
Why prescribe the drug "potassium citrate"?
There's a reason for this:
The old lady herself lacks bicarbonate, if the patient is supplemented with "potassium chloride", then chloride ions will increase, the concentration of bicarbonate will further decrease (combined), and aggravate acidosis!
At this time, the potassium in the cell is transported outside the cell and then excreted through the kidneys, aggravating the loss of potassium.
At this time, supplementing potassium chloride will not only not increase potassium ions, but will make potassium ions - the more supplemented, the lower it gets!
The best way is to supplement "potassium citrate"!
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ps: The latter case, a little complicated...