Chapter 487: Improve Again!

Remember [new] in one second! At this moment, the nurse hurried over again.

"Lu Chen, the old man your team just recruited has high blood sugar on his fingertips again!"

"High again?" Lu Chen frowned. The patient's fingertip blood sugar exceeded the upper limit of measurement again.

"Didn't you already drink so much fluid?"

After all, even if insulin is not used and the blood is diluted, blood sugar will drop!

"okay, I get it."

Lu Chen immediately opened the patient's test inquiry column.

At this time, the biochemical results of the patient's urgent examination in the CCU were also reported: creatinine 459mmol/l, urea 55.41mmol/l, glucose 25.17mmol/l, serum potassium 4.35mmol/l, and serum sodium 154mmol/l!

When Lu Chen saw this result, he looked stunned.

"Lu Chen, what's wrong?"

Gu Xinyue saw that Lu Chen's expression was abnormal and quickly came over. He also saw the test results on the computer.

"The patient's blood sugar and creatinine are so high?!" Gu Xinyue said, "Although the result is abnormal, there is no need to be so surprised, right?"

In the CCU ward, there are many patients whose creatinine and blood sugar levels exceed this old man's.

Lu Chen said in a deep voice: "The results are just superficial. From this biochemical list, you can see more things."

Gu Xinyue frowned. What else could be seen from an ordinary biochemistry sheet.

He was just thinking about it when he heard Lu Chen continue: "At this time, the patient's effective plasma osmotic pressure is (154+4.35)*2+25.17=342 mosm/l, which has clearly exceeded the limit of 2."

"If the influence of bun is added, the plasma osmotic pressure has reached 3

"397?" Gu Xinyue was shocked, "This... such a high osmotic pressure?"

Lu Chen nodded slowly and continued: "I just took a look at the patient's test results two days ago. The plasma osmotic pressure at that time also reached 336 mosm/l. It was not much higher at the time, so it was not taken seriously."

When it comes to this, Gu Xinyue, as a top student in Jinghua Second College, immediately understood!

Gu Xinyue glanced at Lu Chen and said, "So, the rapid increase in osmotic pressure is the root cause of all the patient's clinical manifestations: changes in consciousness, oliguria, hypovolemic shock, and acute kidney injury."

"That's right!" Lu Chen nodded slightly, "This patient does not have cerebrovascular disease, heart failure, or kidney failure, but a typical type 2 diabetes with high glucose and hyperosmolar state!"

This also makes sense, why the patient’s health value trend has always been three minus signs!

If the diagnosis is wrong, the corresponding treatment will be very different.

At this moment, Gu Xinyue suddenly realized.

"If you need to tell Teacher Zhou Bin quickly, I'll go find her." Lu Chen said.

"Okay, I'll go with you." Gu Xinyue followed closely.

…

Zhou Bin is helping patients in other groups perform cardiac ultrasound.

In the entire CCU ward of Jinghua Second Hospital, Zhou Bin's echocardiography technology is considered top-notch.

"You need to adjust the probe to an angle here. Look, can't you see clearly?"

"Teacher Zhou's technique is really good. I just watched it for a long time and could only make a blurry image."

"Ultrasound has no special skills. Practice makes perfect."

Zhou Bin smiled, but at this moment she was thinking of Lu Chen.

This second-year graduate student has already surpassed her in ultrasound!

…

At this time, Lu Chen and Gu Xinyue rushed to Zhou Bin's side.

"Teacher Zhou, the biochemical results of the 6th bed old man are out!" Lu Chen said quickly.

Seeing Lu Chen's anxious look, Zhou Bin also felt that the patient's condition might have exceeded everyone's expectations.

She put down the cardiac ultrasound probe and said quickly: "What's wrong?"

Lu Chen directly handed over a test sheet, "I just calculated the osmotic pressure, it's at least 397!"

"The osmotic pressure is so high?" Zhou Bin took the test form, stood up immediately, and walked towards the doctor's office, "Is it a hypertonic state of diabetes?"

Zhou Bin is worthy of being a senior attending doctor. He reacted immediately and hit the key point - the hyperosmolar state of diabetes.

"I think so!" Lu Chen nodded.

Diabetic hyperosmolar state is common in elderly people with type 2 diabetes over 60 years old.

Most of the triggers are infection, acute gastroenteritis, pancreatitis, cerebrovascular accident, insufficient water intake, large intake of sugary drinks, etc.

This patient happened to have one thing, that is, he consumed a large amount of sugary drinks.

Due to the gradual increase in osmotic pressure, central nervous system symptoms occur, including limb weakness, convulsions, and progression to coma and hypovolemic shock.

…

Back to the doctor's office.

Zhou Bin took out all the patient's examinations and tests.

Doctors from other groups joined in whenever they were free.

Zhou Bin said slowly: "Actually, when we look back and analyze this patient, from the triggers to clinical manifestations to laboratory tests, they all conform to a very typical hyperglycemic and hyperosmolar state."

Lu Chen nodded and agreed: "However, due to our fixed clinical thinking, we preconceived the patient as acute exacerbation of chronic heart failure and cardiorenal syndrome from the beginning."

"It ignores the early significant elevation of blood glucose and mildly elevated plasma osmolality."

"During the initial treatment, a large amount of hypertonic fluid was supplemented for the patient, and a large amount of diuretics were used. Not only did we miss the best time to correct hyperglycemia and hyperosmosis, but it also fueled the disease."

The stubborn "three minus signs" on the old man's life value are the best proof.

Preconceived ideas often lead patients to extreme treatment.

The first place the old man went to was the eighth area of ​​the heart.

When it comes to the cardiology department, the diseases in their own department naturally come to mind, such as heart failure, cardiogenic shock, etc.

However, the real cause of the patient's disease is often hidden deep.

Without broad clinical thinking ability, the final correct answer cannot be obtained.

On the contrary, the patient will delay the treatment opportunity due to narrow diagnosis.

...

Just when Lu Chen finished these words, a prompt suddenly popped up on the system panel.

"Congratulations, your clinical thinking ability has improved!"

A simple prompt without any remarks.

After Lu Chen participated in a discussion of difficult cases in the cardiology department, UU reading books www.uukanshu.net also received this prompt.

However, there was no detailed explanation of what the specific effect was and how much the ability was improved.

However, Lu Chen also relaxed his mind. It is better to have it than not to have it!

...

At present, the diagnosis is clear.

The next step is to adjust the treatment measures.

The key to the treatment of hyperglycemic hyperosmotic state of diabetes is to quickly replenish the body fluids and electrolytes lost due to osmotic diuresis and reduce the osmotic pressure.

"Continue to replenish fluids." Zhou Bin said.

The word "replenishment" is easy to say.

But how to replenish and what to replenish is a big problem.

What's more, the patient has a history of long-term chronic heart failure. Large doses of fluid replenishment are likely to cause an acute heart failure.

Without fluid replenishment, the osmotic pressure cannot be reduced and the cause of the disease cannot be solved.

This big problem is in front of everyone again.