Acute liver injury, severe acidosis, chronic anemia...

Xu Qiu tried to find clues about the culprit of the disease.

However, the next moment, the patient's condition took a sharp turn for the worse again.

vomit!

Ding Tao felt a strong pressure from her stomach rushing out, and the muscles in the digestive tract seemed to be spasming from bottom to top. She vomited in pain, and she was dry and retching.

"Didn't have lunch?" Xu Qiu asked when he saw this.

It's past three o'clock in the afternoon. If you eat at meal time, you will definitely not have time to completely digest it now, so you won't be able to spit out any of it.

"Yes, she was more than 20 kilograms heavier after giving birth than before, saying that she wanted to lose weight." Ding Tao's husband was heartbroken in his eyes. Although it was useless, he still patted his wife's back.

Didi--

Soon, the monitor began to call the police and the patient's condition began to worsen again.

Xu Qiu frowned gently... As expected, as he predicted, before the root of the disease is found, all the improvement is just an illusion. Patients may still be critically ill at any time. Only staying in the ICU can save their lives.

I forced myself to stay in the ordinary ward, lacking life-sustaining equipment, and all kinds of life-saving facilities are not as complete as there. When I was sent to the ICU, I would be cold.

"Turn the ICU." Xu Qiu said lightly.

This also means that the real money-burning life has begun.

On the first day alone, the starting fee for several important equipment was 40,000 yuan. This was still the case when ECMO was not used. If ECMO is added, ECMO, blood filtering, etc. were added, the medical expenses on the first day could easily exceed 200,000 yuan.

That is not a life-suspending technique that ordinary people can afford.

“It’s kind of like lgA kidney disease.”

In the office, Xu Qiu repeatedly checked Ding Tao's medical records and made speculations.

Shi Lian opened his mouth slightly and said, "The patient has no history of respiratory infection before, and has no hematuria..."

lgA nephropathy has two characteristics.

First, the disease occurs one to three days after upper respiratory tract infection.

Second, the patient has hematuria in the naked eye or microscopic hematuria.

But Ding Tao did not meet both.

Xu Qiu shook his head: "What textbooks teach are typical manifestations of classic diseases."

The patient's main problem was acute liver injury, but he still grasped the fact that blood creatinine exceeded the standard in renal function examination.

Renal disease progresses to renal insufficiency, which then induces metabolic acidosis.

If lgA kidney disease can be diagnosed, at least acidosis can be explained.

"Appoint a renal biopsy pathology and then immunofluorescence."

If these two checks are done in a regular process, it will take about a week to produce results.

But Lin Medical has long opened a green channel to make way for expedited patients.

The next morning, the two results were released.

Renal biopsy pathology showed that diffuse mesangial hyperplasia could be seen in the patient and local segmental hyperplastic glomerulonephritis was found.

Another immunofluorescence suggests that IgA-based immunocomplexes were found in the mesangial region!

These two results directly target lgA kidney disease, even if the patient does not have a typical history of hematuria.

This made the doctors in the emergency department and urology department a little excited for a moment.

Could it be that the culprit of the disease comes from this lgA kidney disease that has been hidden for so many years?

Xu Qiu was not sure either.

Faced with unknown complex diseases, he could only adapt to the situation.

The current task is to first control lgA kidney disease to see if Ding Tao's condition is relieved. If the treatment is effective, the root cause is likely to be related to lgA kidney disease.

...

However, the treatment of lgA kidney disease is also a major difficulty.

There is no special treatment method for this disease. You can only formulate personalized plans based on experience based on the patient's performance, disease typing and course.

For example, lgA nephropathy with isolated microscopic hematuria is a blessing in disguise. Most of them have no clinical manifestations and do not require special treatment. Regular follow-up is enough.

On the contrary, repeated attacks of the naked eye hematuria type or abnormal urine test type basically rely on triple therapy of triplet polygonads, emodin and ACEI/ARB.

Ding Tao's third type: vasculitis type.

This is also the most complex classification in lgA nephropathy.

It is precisely because the mechanism, manifestations, pathogenic principles of this classification have not been studied thoroughly, so Xu Qiu was unable to determine whether the lgA kidney disease that caused Ding Tao's critical illness was lgA kidney disease.

"Please adopt the MMF solution."

After considering for more than ten minutes, Xu Qiu confirmed the doctor's order.

Methylprednisol impact treatment lasts for three days.

After that, the treatment was continued with prednisone 36 mg every day.

If it is just ordinary lgA nephropathy, this treatment plan will last at least half a year, reducing the dose of 5 mg of prednisone every two weeks until it is maintained at 10 mg per day...

Dan Ting Tao is different.

She is still lying in the ICU now, and her life is hanging on the line, so it is impossible for her to slowly treat lgA kidney disease.

The safest way is to see if methylprednisol impact treatment can relieve the condition. If so, continue to deal with lgA kidney disease. If the body does not improve, the priority of kidney disease will be very behind.

On the first day of the MMF treatment plan, Ding Tao's condition was not much different from before.

The next day after the impact treatment, the internal environment was still in a disordered state, and the use of medicine could only ensure that it was not life-threatening.

On the third day, renal damage continued to progress, and liver function damage also did not improve.

Xu Qiu's face changed.

The patient does have lgA nephropathy, but this can only explain the abnormal renal function indicators and has nothing to do with the patient's severe acidosis and acute liver injury.

Last year, he also diagnosed a patient with acute liver damage and chronic anemia.

He was a college student who was a micro-businessman. He bought a batch of meal replacements and weight loss pills. He usually ate meal replacements and was also taking weight loss pills he sold.

As a result, there is a serious problem of nutritional imbalance in meal replacement, while the weight loss pill has the banned ingredient Sibutramine. The two are superimposed, allowing the patient to step into the gates of hell in a short period of time.

But Ding Tao was completely different. She was pregnant some time ago. For the sake of the child in her belly, she had not taken any medicine for more than a year, and had never touched medicine for nearly a month after giving birth.

In this case, the easiest cause of liver damage to trace is eliminated.

"What is the connection between chronic anemia, acute liver injury and severe acidosis?" Xu Qiu fell into deep thought.

This is the key to diagnosing the disease.

The patient has heart failure, which is definitely related to chronic anemia.

However, is chronic anemia and the other two diseases a causal relationship or a juxtaposition relationship?

Also, is acute liver injury causing severe acidosis, or does the progress of acidosis damage the liver?

Different orders represent completely different diseases.

If it is the former...

The liver participates in the regulation of acid-base balance through four pathophysiological mechanisms, including lactic acid metabolism, albumin homeostasis, ketone body production, and urea production.
Chapter completed!