When doctors have a simulated operating room

Zhang Yi looked up at the woman.

She looked very dignified and elegant, but why did she seem to have a sense of resentment between her eyebrows?

Was it Zhang Yi's illusion?

The patient's wife also realized that she seemed to be a little too emotional, and her face changed immediately.

She quickly held the patient's arm and asked worriedly:

"Husband, I mean, is your illness so serious? Is it serious enough to need hospitalization?"

The mood changed very quickly, maybe just one or two seconds.

The patient didn't feel anything wrong, but Zhang Yi always felt a little strange.

Did he think too much?

"Yes, hospitalization is indeed recommended for his current condition. You see, his blood potassium index is 5.7. The normal range should be 3.5-5.5. Yours is a little higher.

If the high blood potassium is caused by food, I can give you some diuretics or just suggest that you don't eat so many potassium-containing foods.

But your high blood potassium is caused by renal insufficiency, which is very dangerous.

If you receive infusions in the outpatient clinic by yourself, if your condition suddenly worsens when you go home at night, your renal function will further weaken, and blood potassium cannot be discharged. The consequences of potassium ions being blocked in the body are very serious.

So I suggest that you be hospitalized for treatment and arrange a bed for you in the Department of Nephrology."

"Ah? This... you have to be hospitalized now?" The patient's wife muttered.

The patient seemed to have some concerns and asked:

"Doctor Zhang, I'm very busy at work. If I'm hospitalized, do I have to stay in the hospital every day?"

"Under normal circumstances, it is definitely recommended that you stay in the hospital, because this way our doctors can observe your condition at any time.

But if you really have something to do, you can go out, but you have to sign a leave note before you leave the hospital, which is similar to a letter of responsibility.

We are responsible for your safety in the hospital, but if you insist on leaving the hospital, then our hospital will not be responsible if you have other situations outside."

"Oh~ then... okay, I'll be hospitalized. If I'm really busy at work, I'll just take a leave."

In the end, the patient decided to be hospitalized.

After all, Zhang Yi also said that once the condition worsens, high blood potassium will kill people.

This still sounds scary, right?

On the side, his wife also nodded.

Zhang Yi deliberately looked at the expression on his wife's face. At this time, his wife's face was full of worry.

It's just a very common relationship between husband and wife, the husband is sick and the wife is worried.

Could it be that Zhang Yi had misread the flash of anger just now?

"Okay, then I will arrange for you to be admitted to the Department of Nephrology."

After saying that, Zhang Yi began to print the admission form.

The admission diagnosis on the admission form is: 1. Renal insufficiency 2. Chronic nephritis?

Zhang Yi currently considers that the cause of this patient is renal insufficiency caused by chronic nephritis.

But combined with the increase in neutrophils, toxic nephritis can also be suspected.

In short, if he enters the Department of Nephrology, their doctors will do further examinations.

Soon, the patient took the form to the Department of Nephrology to apply for hospitalization.

I thought that this patient would be cured safely and then discharged.

Unexpectedly, three days later, the Department of Nephrology suddenly called.

"Doctor Zhang, you were the first to see Jiang Yimin on the day he was admitted to the hospital, right?"

Zhang Yi answered the phone with a confused look on his face: "Yes? What's wrong? What happened?"

"Nothing, his condition suddenly worsened, I called to ask you, in addition to the symptoms you wrote in your chief complaint on the day he was admitted to the hospital, are there any other symptoms that you missed?"

Zhang Yi thought for a long time, but he really couldn't think of anything else that he missed.

The chief complaint he wrote must be fine.

So Zhang Yi went straight to the Nephrology Department after hanging up the phone.

In the ICU of the Nephrology Department, Zhang Yi saw Jiang Yimin lying on the bed as soon as he came in.

Several monitor tubes and oxygen were arranged on his body, and two intravenous channels were inserted in his arms.

Zhang Yi was shocked when he saw it!

What's going on? ?

How come he looks like this after just a few days of not seeing him? ?

Zhang Yi frowned and walked to the bed to take a look.

Wow, renal insufficiency turned into acute kidney injury in three days? ?

Fortunately, the nephrology department rescued the patient in time, and the patient should be able to be saved.

At this moment, Li Xigui, deputy director of the nephrology department, who rushed in after hearing the news, also walked in.

Director Li

The family members followed him, namely Jiang Yimin's wife and a young man.

It should be his son.

"Zhang Yi, I just want to ask you, is there any abnormality in the liver function of this patient on the day he was admitted to the hospital?"

"Liver function? There was nothing wrong with the liver function on the day he was admitted to the hospital. I checked it."

"That's really strange. After three days of infusion, his condition should have improved, but I didn't expect that he took leave last night and came back three hours later. He got worse this morning.

We did an emergency check this morning and found that there was also a problem with the liver function indicators."

Director Li showed the checklist in his hand to Zhang Yi.

Alanine aminotransferase: 78U/L (9-50U/L)

Aspartate aminotransferase: 58U/L (15-45U/L)

Total bilirubin: 25umol/L (2-22umol/L)

"Transaminase is so high?? It can be considered acute liver damage and toxic hepatitis."

After reading it, Zhang Yi directly gave a possible diagnosis.

Liver function can generally be done in five, six and thirteen items.

But generally, the indicators to look at are transaminase, total protein and bilirubin.

As long as the transaminase is elevated, it means that the liver cells are damaged.

The albumin value can reflect the protein metabolism and synthesis of the liver.

The bilirubin value can effectively reflect whether the liver's excretion, secretion, and detoxification functions are normal.

Above, Jiang Yimin's items are all wrong.

If it is not acute liver function damage, it is obviously toxic hepatitis.

Combined with the fact that the patient's heart and lungs were fine, it can even be said that there were no problems with other parts of the patient's body at the beginning.

Only one kidney was weak.

Now, the liver and kidneys are both problematic.

Zhang Yi's first reaction was that there was a problem with metabolism.

It's a very simple logic. The liver and kidneys are both excretory organs of the human body, one for detoxification and the other for urination.

Now that both metabolic organs have problems, there must be something in this person's body that makes these two metabolic organs overloaded.

Therefore, this person's kidneys will first become weak, and now the liver is also damaged.

Zhang Yi looked up at the patient and his family, and finally his eyes fell on his wife.

However, Zhang Yi just looked at it. Although he had doubts in his heart, he did not ask directly.

Instead, he turned to look at Li Xigui:

"Director Li, this patient should have acute liver and kidney damage. This condition was not present when he was first admitted to the hospital.

When he came to the outpatient clinic, he was in good condition, he could talk and laugh, his liver function was normal, and there was no problem with other parts of his body.

I saw the current check list, you also did a cardiac ultrasound, and there was no problem with the heart.

Then let's see if the patient ate or drank something during the few hours he was away last night?"

After Zhang Yi finished speaking, Director Li also looked at the family members next to him.

The patient is now in a semi-comatose state, and asking him will definitely not give any results.

You can only ask the family members.

The patient's son looks quite young, and he seems to be less than 20 years old.

Upon hearing what Zhang Yi said, his son asked anxiously:

"But...but my dad didn't eat or drink anything yesterday? I remember he just went to a dinner party yesterday that he couldn't postpone."

"Dinner party? Did your dad drink?"

"My dad doesn't usually drink. He doesn't have an alcohol addiction. He just likes to smoke. If he has to go out for social events, he will drink as little as possible."

This is strange.

It is true that alcohol damages the liver, but this patient did not suffer from acute liver and kidney damage caused by alcohol.

What is the reason?

At this time, Jiang Yimin's wife suddenly said as if she remembered something:

"By the way, doctor! My husband usually likes to eat pickles and pickled vegetables! Will this...will this have an impact?"

"Pickles? Well...overly salty food does have an impact on the liver, but..."

"Well? Does dad like to eat pickles?"

Zhang Yi was halfway through his words when his son pulled his mother's arm and asked in a low voice.

Just this action made Zhang Yi frown.

This family is a bit strange. The wife said that her husband likes to eat pickles, but as a son, he doesn't even know that his father likes to eat pickles?

So does Jiang Yimin like to eat pickles? ?

It seems that this question can only be asked when Jiang Yimin wakes up.

"Let's put it this way. Jiang Yimin's current condition is stable, but the cause of the disease is still a mystery. It is not caused by alcohol or other foods.

So our doctors have to hold another meeting to discuss it.

Director Li, let's

Let's go to the office to discuss it first. "

As he said, Zhang Yi pulled Li Xigui out of the ICU.

When they left, the patient's wife urged them nervously:

"Doctor Zhang, you are so good at medicine, you must help us find out the cause of the disease! Otherwise, what should I do with my husband's condition in the future?"

"Okay, no problem, we will do our best."

After saying this, Zhang Yi turned and entered the doctor's office of the Department of Nephrology.

Behind him, Director Li also frowned and looked thoughtful.

"This patient does have toxic hepatitis, and today's liver function test can also be inferred that his kidney function problems may also be due to poisoning."

Li Xigui said after thinking for a while.

Zhang Yi nodded: "Director Li, you and I think the same."

After Zhang Yi pulled Li Xigui to the room inside the office, he closed the door.

Seeing his serious and vigilant look, Li Xigui hurriedly asked:

"What's wrong, Doctor Zhang? Do we have to close the door and talk about this disease alone? "

After closing the door, Zhang Yi asked a question that had nothing to do with the condition.

"Director Li, what do you think of the patient's wife?"

"Ah?!" Li Xigui widened his eyes and looked at Zhang Yi in disbelief!

Oh my God!

Zhang Yi is such a young man, but he is actually interested in that kind of aunt in her forties??

"Don't get me wrong, I mean have you felt that there is something wrong with his wife these days?"

"Oh... I thought you... ahem! You mean his family members?"

"Yes."

Li Xigui thought for a while and shook his head:

"No, his wife is very good. When we were making rounds, we often saw his wife taking care of him for meals. She is also very nice. She also sent fruit to our medical staff yesterday morning. ”

Seeing Zhang Yi’s serious face, Li Xigui suddenly thought of something and immediately reacted and asked:

“Wait, you mean… Jiang Yimin’s illness was caused by his wife? Do you suspect his wife poisoned him? ? ”

Zhang Yi neither nodded nor shook his head, because he had no evidence at the moment.

If we only judge that his wife wanted to harm him based on the words and the fleeting look in the clinic three days ago, it seems a bit too arbitrary.

Finally, Zhang Yi sighed and said:

“I’m not sure, but I think the patient’s current cause of illness can almost be diagnosed as liver and kidney damage caused by poisoning. Although it has not yet developed to the point of renal failure, the attending physician and nurse must closely observe.

Also, I suggest that the nurse should also take a look at what the patient eats every day.

See if there is any strange combination. Some food conflicts may also cause poisoning.

Of course, if the whole family eats this kind of food, his son and wife are fine, but he is.

Then I really have to suspect that there is something wrong with his family.

After all... I have seen a case before, that is, a boyfriend of the chemistry department made poison and secretly gave it to his girlfriend. He took a little bit every day, and the woman had kidney failure without anyone noticing.

So... I think it is right to be more careful. "

The more Li Xigui listened, the more he felt it made sense.

"Doctor Zhang, you are right! If it is true what you said, it is very likely that the patient's family poisoned him!

Let's do this, we will ask again after the patient wakes up. If I find anything wrong, I will call the police immediately. "

"Well, okay, please call me again when the time comes.

Also, we are just suspecting it at the moment, I suggest not to tell anyone first, so as not to alert the enemy.

What if it is finally discovered that the patient may have eaten some pickles or incompatible foods, wouldn't it be a misunderstanding of the family?

But what if it is really the family who secretly poisoned, then asking the family now will definitely make this person alert, and what if he runs away at that time? ”

It’s better to be low-key. If the final result is the former, there will be no suspicion, and no misunderstanding will cause unnecessary trouble to the family members.

If it is the latter, it will be convenient to call the police to arrest people.

This kind of secretly poisoning behavior can be said to be intentional homicide, and the law will never let it go easily.

“Okay, no problem, I will call you when the patient wakes up. Um... I will give a medical order for examination, and let the doctor and nurse go with him. Ask him about the details on the way. ”

In this way, Zhang Yi and Director Li discussed the countermeasures.

The cause of the patient’s disease cannot be found at present, but it is diagnosed as liver and kidney damage caused by poisoning.

So what is this poison?

Where does the poison come from?

These questions are the key factors for doctors to prescribe treatment.

Therefore, this "poison" must be found so that the patient can be completely cured and discharged from the hospital.