Doctor of Healing

Chapter 290 Sequelae of Ceftriaxone
"The patient has small stones, but the stones will not affect urination." Director Liu said with certainty, "Director Xu, I don't think the kidney function is particularly bad. Why don't you try dialysis for a few days."

"I just don't understand why." Director Xu of the Nephrology Department frowned and said, "I know it has nothing to do with you, but..."

As she spoke, she stopped talking.

This consultation is indeed a bit nonsensical, but Director Xu has no choice but to give it a try and see if Director Liu of the Department of Urology has any ideas.

"It has nothing to do with us." Director Liu smiled and repeated.

As soon as the words were finished, Director Liu suddenly felt his foot was kicked lightly.

It's Ji Xiang!
He is reminding himself! !
Director Liu was taken aback, realizing that there might be a problem, and immediately recalled the patient's imaging data, past history, and current targeted treatment.

Nothing wrong, this patient has nothing to do with urology!

But he kept his composure, stood up and said, "That's it for now, I'll go back and think about it."

"Thanks for your hard work, Director Liu, please write a note for the consultation."

"okay."

Director Liu and Ji Xiang left the nephrology department, and as soon as Director Xu disappeared, Director Liu immediately asked, "Xiaoji, what do you think?"

"Director, the patient received ceftriaxone in the local hospital." Ji Xiang whispered.

"Ceftriaxone? There's nothing wrong with it. Broad-spectrum antibiotics are effective against Staphylococcus aureus, Streptococcus, and Pseudomonas aeruginosa. The medication at that time was considered symptomatic."

Director Liu still doesn't know what Ji Xiang is going to say.

"Director..." Ji Xiang didn't know what to say.

"Xiao Ji, just say what you have to say, and you don't have to think that I am the director." Director Liu raised his head slightly, looked at Ji Xiang and said seriously.

"The drug instructions for ceftriaxone sodium mentioned the possibility of extremely rare gallstones."

"..." Director Liu was taken aback, he didn't know about this at all.

Ceftriaxone sodium is a commonly used clinical drug, and its effect is quite good, but this drug can also form gallstones?

Director Liu was stunned.

"Theoretically, ceftriaxone sodium has a higher drug solubility and is less likely to form urinary stones.

When the blood volume is reduced, the urine flow rate is reduced, and the drug is used in large doses, the drug concentration will reach a peak in a short period of time.

Ceftriaxone ions and calcium ions in urine form ceftriaxone calcium, because ceftriaxone calcium is insoluble in water, and then crystallize in the ureter and form pseudolithiasis, leading to acute urinary tract obstruction and acute renal failure Exhausted. "(Note)
Ji Xiang recounted the theory that the system NPC told him in detail.

In fact, Ji Xiang is not very sure, the theory of system NPC is too bizarre, kidney failure can be caused by antibiotics, Ji Xiang does not quite understand.

Director Liu was taken aback when he heard that.

But Director Liu had already knelt down a long time ago, starting with the puncture of the cavernous body, and the incredible cases after that made Director Liu unable to think of questioning.

"How to diagnose?" Director Liu asked with a frown.

"Animal experiments and in vitro experiments have shown that the formation of ceftriaxone stones is positively correlated with the concentration of calcium ions and ceftriaxone in urine, and negatively correlated with the concentration of citric acid in urine."

"But for inspection, I'm afraid we don't have it in the Second Affiliated Hospital, so I'd better take a look in the mirror."

Ji Xiang suggested.

"Okay." Director Liu turned around, hesitated for a moment and picked up the phone.

"Old Gao, I, Liu Zhi, help me read the ceftriaxone instructions."

"Why do you talk so much, I may encounter a patient with problems."

"It's not an allergy. I don't know about that kind of thing. Let's take a look at the instructions for ceftriaxone to see if it says it causes gallstones."

Director Liu was not embarrassed for questioning Ji Xiang's statement, he waited intently for the reply from the director of the pharmacy department with his mobile phone.

Ceftriaxone sodium is not metabolized in the body, 60% is excreted by the urinary system, and 40% is excreted by the biliary tract and digestive tract.

If gallstones can form in the gallbladder, so can the urinary tract, although they are quite rare.

So he cautiously asked the director of the pharmacy first.

Soon, the phone rang, and the director of the pharmacy opposite seemed surprised, and the voice was a few decibels louder.

Director Liu's orbicularis oculi muscle twitched a few times.

"I see, thanks."

After hanging up the phone, Director Liu looked at Ji Xiang in surprise.

"Xiaoji, do you read all the drug instructions? And can you memorize them?"

Ji Xiang was a little ashamed. Wherever he knew it, it was turned on by the system npc.

Seeing that Ji Xiang had a different expression, Director Liu raised his hand and patted Ji Xiang on the shoulder with a smile.

"It's a good thing. I'm not jealous of the virtuous and the capable. Xiaoji, be a mirror with me later."

"Good director."

Director Liu didn't hesitate anymore, and turned back to look for Director Xu.

"Director Liu, why are you back? Did you drop something?" Director Xu of the Department of Nephrology was startled.

"Xiaoji reminded me, I suddenly remembered something."

Director Liu "translated" Ji Xiang's words again. Although there were some missing things, Director Xu, who was in his mind, could understand.

"Director Liu, why haven't I heard of it?" Director Xu questioned without hesitation.

"Prepare to be a mirror, take a look, no matter what is going on, it will be clear at a glance."

"Make a mirror?" Director Xu was stunned, she didn't understand why a mirror was made.

"Director Xu, you haven't made a diagnosis, and you don't know what's going on. I propose a possibility and you still don't believe it." Director Liu immediately lowered his face, "If you don't want to, I'll go back. I'm tired after a day of surgery. Die, who wants to use the mirror in an emergency."

"Don't introduce!" Director Xu immediately apologized, "Director Liu, look at you. I just don't understand why you are still angry. You are not like this usually, don't be stingy."

She checked the information when she was about to send the patient to the urology department.

After using ceftriaxone for so many years, Director Xu, like Director Liu, did not know that there was a possibility of stone formation.

"Director Liu, is there any other diagnostic method?" Director Xu asked casually.

"Xiaoji, tell me." Director Liu was proud.

"The most reliable way to diagnose ceftriaxone stones is infrared spectroscopic analysis, but our Second Affiliated Hospital has not yet carried out such examinations.

Diagnosis still needs to be combined with the patient’s medical history. When a patient develops symptoms of renal colic after recent use of ceftriaxone sodium, accompanied by sudden oliguria or anuria, the first consideration should be the possibility of acute postrenal renal failure caused by ceftriaxone stones. possible. "

"While unlikely, it does happen from time to time."

"..."

Director Xu felt bad after hearing Ji Xiang's explanation.

What Ji Xiang said was so professional that he didn't even understand what he heard, which made Director Xu a little embarrassed.

……

……

Note: Ceftriaxone caused gallbladder stones was written earlier in the live broadcast room, but I didn’t know that it could also cause kidney disease. I was surprised when I read the paper.

Source quoted from - Journal of Clinical Urology, Issue 2015, 3.

(End of this chapter)