473 is thallium poisoning

Su Yang thought for a long time before he decided to confirm whether the patient was thallium poisoning.

Thallium poisoning has many symptoms and is not specific, and can affect multiple systems throughout the body, so early diagnosis is difficult and treatment is often delayed. The clinical manifestations of thallium poisoning depend on the dose of poisoning, contact time, weight, individual tolerance and start treatment. Gastrointestinal symptoms, neurological disorders and skin lesions are the main manifestations of acute thallium poisoning.

Currently, most scholars believe that atomic absorption spectroscopy to determine the thallium content in patients’ urine is the gold standard for confirming thallium poisoning.

The symptoms after thallium poisoning are often peripheral neuropathy, such as abnormal sensation at the ends of the limbs, weakness of the distal muscles of the limbs, and reduced tendon reflexes, so thallium poisoning is easily misdiagnosed as Guillin-Barre syndrome.

At present, there have been many reports of thallium poisoning being misdiagnosed as Green-Barre syndrome at home and abroad.

Su Yang then started experimental treatment again.

This time, he was not busy with treatment, but first measured the thallium content in the patient's urine by atomic absorption spectrometry.

The result shocked Su Yang.

The patient's urine really contains thallium.

But the content is not that high!

Combined with the patient's previous consultation, Su Yang guessed that the patient should have been chronically poisoned, or more accurately, someone poisoned the patient every day.

grass!

Seeing this result, Su Yang couldn't help but curse.

Once this result is announced... the consequences are really unimaginable!

Because this matter was too serious, Su Yang decided to make another confirmation.

However, once confirmed, treatment will not be so troublesome.

For a long time, Prussian blue, hexacyanoferrate, which is the most effective antidote for thallium poisoning, has destroyed the enterohepatic circulation of thallium by forming an insoluble complex with thallium ions in the intestinal tract and strengthening fecal excretion.

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The method of taking it is 250\/    kg daily, 4 times orally taken, each time dissolved in ml     15% or 20% mannitol.

Hypokalemia is a common adverse reaction to the use of Prussian blue to treat thallium poisoning. Therefore, the blood potassium level needs to be routinely monitored during the application process. During the use of Prussian blue, potassium supplementation is required to maintain the blood potassium concentration at the high limit of the normal range (4.    5     5.     0     mmol      \/l) to facilitate the excretion of thallium, but it is necessary to pay attention to the initial h                                                                                                                                                                          �

According to literature reports, after the human body intakes thallium, the half-life of thallium excretion without treatment is about 8.    0    d, after using Prussian blue, it is 3.    0    d. Blood purification treatment is started after thallium intake, and the half-life is only 1.    4   d.

Therefore, Prussian blue and hemodialysis are the cornerstone of the treatment of acute thallium poisoning, where hemodialysis has been proven to be effective within 3 weeks after thallium poisoning.

Blood purification combined with Prussian blue, potassium supplementation is the most effective method to treat thallium poisoning.

Patients with thallium poisoning should avoid taking nonsteroidal anti-inflammatory drugs, as they can cause gastrointestinal discomfort and liver and kidney damage. It has been proved that early diagnosis and treatment of thallium poisoning can improve survival, shorten the course of the disease, and minimize the degree of nerve damage. In addition, patients with thallium poisoning have sufficient supplementation.                                                                                

Su Yang immediately gave the patient Prussian blue. Although the best time for hemodialysis is within 3 weeks, and the patient's poisoning time has obviously exceeded three weeks, in order to reduce the damage to poisoning, Su Yang decided to continue hemodialysis. In addition to hemodialysis, Su Yang also supplemented potassium, protected the stomach, liver, nourished nerves and symptomatic support for treatment. The patient's condition recovered well and the neurological damage was mild. He continued treatment for a period of time and the patient was discharged from the hospital after recovery.

At this point, Su Yang had no doubt that the patient was thallium poisoning.

Although this conclusion is a bit shocking, as a doctor, he had to respect the facts.

Su Yang quickly came out of the system space.

At this time, everyone basically agreed to treat Guillin-Barre syndrome first.

Su Yang hurriedly expressed his objection: "The dean and all the colleagues here, I have different opinions on the diagnosis of the patient."

Li Qiulin looked at Su Yang: "You said."

"Director, I think the patient should be thallium poisoning!"

What?

Thallium poisoning?

As soon as Su Yang finished speaking, everyone's hearts were in an uproar.

But no one talked loudly, everyone just looked at Su Yang like a fool.

In fact, to be honest, some people suspected that thallium poisoning was caused by the previous one, but it was quickly rejected. For several reasons, first, the symptoms of thallium poisoning are not particularly obvious, especially hair loss. The patient started to lose hair a long time ago. In addition, the patient's fingers and toes did not have white cross-bone lines, namely the Mi-branded line. These are important basis for judging thallium poisoning, but this patient is not particularly obvious. This is one of the first points; second and most important points, previous consultations have shown that the patient has no possibility of contact with thallium. So, once the patient is thallium poisoning, there is only one possibility, but no one dares to talk about the possibility of contacting the patient's identity!

So at this time, everyone reacted like this after listening to Su Yang's words.

But Su Yang ignored everyone, he just continued: "Dean, I have a basis. First, although the patient also had hair loss before, if you carefully study the patient's previous resume, you will find that although the patient had hair loss before, it was not serious. The patient started to lose hair since he was forty, but it was not until he was in his fifties that he had baldness. However, just now everyone saw that the patient's hair was already very bald. These places obviously began to appear after poisoning."

"Secondly, if the patient has Guillin-Barre syndrome, then the following characteristics must be possessed: 1. Before the disease, 1. ~ 4. 4.                                                                                                                                                                                                                                        �

The main characteristics of clinical manifestations of thallium poisoning are: First, myasthenia is not common, and the degree is mild, and does not develop progressively, which is basically consistent with the patient. Second, tendon reflex is relatively reserved and even active, which is consistent with the patient. Third, almost all thallium poisoning suffer from liver damage, resulting in increased blood alanine aminotransferase, aspartate aminotransferase, bilirubin, and γ-glutamyl transpeptidase, which is consistent with the patient's situation. If we add the hair loss we analyzed before, then the differential diagnosis will obviously be clearer. Of course, if you want to confirm the diagnosis, you can only do an atomic spectrum examination. Director, even in case, I suggest to do a related examination!"

Li Qiulin frowned and didn't say anything for a long time. After a while, he picked up the phone and communicated with the chief of the level. Finally, the chief agreed to do the relevant inspection.

The final inspection results

It's exactly the same as what Su Yang said!
Chapter completed!