Doctor Zhao, help!

Chapter 154 Acute renal failure?

Three in the afternoon.

After lunch in the canteen, Zhao Sheng returned to the doctor's office and continued on duty.

Holding a cup of brewed coffee, Song Wei entered the office as soon as Zhao Sheng sat on the chair.

"There is an emergency, and a patient is transferred from the local hospital."

Song Wei looked at Zhao Sheng who was about to drink coffee in Youzaiyouzai and said.

"I haven't had a sip of the brewed coffee yet..."

Zhao Sheng stood up helplessly. The emergency department was like a battlefield or even a fire scene. If there was a situation, he would be rushed to the hospital immediately. He could not waste even a minute.

"Okay, let's go."

Zhao Sheng said to Song Wei.

After a while, Zhao Sheng and Song Wei came to the lobby and saw a middle-aged elder sister who had been moved out of the ambulance. The middle-aged elder sister was already lying on the transfer bed. Her face was swollen and she looked very bad. The other one was wearing glasses and looked very bad. A gentle, gentle, middle-aged man stood next to her, and he looked like he should be her husband.

Zhao Sheng quickly came to the transfer bed. At this time, he observed that the husband, the middle-aged man with glasses, looked at his wife with a look that hates iron and is like looking at a fool.

"what's the situation?"

Zhao Sheng asked Tan Bo, the emergency doctor who was accompanying the car.

"Renal insufficiency caused by acute hemoglobinuria, the local hospital said it was renal failure."

Temple said.

"Huh? Renal failure caused by acute hemoglobinuria? So severe?"

Zhao Sheng was shocked when he heard this.

To put it simply, acute hemoglobinuria means that a large number of red blood cells rupture due to various reasons, and the hemoglobin exceeds the binding capacity of plasma aggregate globin and the absorptive capacity of the renal proximal tubule.

A large number of red blood cells in the human body rupture, which is very rare, let alone lead to kidney failure.

The only situation Zhao Sheng could think of was crush syndrome caused by people being pressed by heavy objects after a natural disaster.

Crush syndrome refers to a clinical syndrome characterized by limb swelling, necrosis, hyperkalemia, myoglobinuria, and acute kidney injury caused by long-term compression of muscle-rich parts of the limbs or trunk.

The core link of crush syndrome is rhabdomyolysis, which causes the leakage of muscle cell contents into the extracellular fluid and blood circulation, leading to a series of complications such as reduced effective circulating blood volume, electrolyte imbalance, acute renal failure, and multiple organ dysfunction. .

"What caused it?"

After a pause, Zhao Sheng asked again.

"I heard that they were doing some kind of slapping therapy, but the details are not clear yet."

Temple said.

"Okay, leave it to me."

Zhao Sheng nodded.

After a while, the middle-aged sister was transferred to the detention ward.

Zhao Sheng looked at the eldest sister lying on the hospital bed. At this moment, the entire face was swollen, and both lower limbs were also very swollen. They still looked vaguely translucent, which meant that a lot of blood had accumulated under the skin. Exudate.

In this case, it is due to renal insufficiency that cannot complete absorption, resulting in exudation and accumulation under the skin.

Moreover, judging from the appearance of the eldest sister, her breathing is already a little rapid, which indicates that edema has also occurred in the lungs.

Song Wei quickly put the elder sister on ECG monitoring. Zhao Sheng saw that the body temperature was 36.3°C, the pulse was 80 beats/min, the respirations were 18 beats/min, and the blood pressure was 180/90mmHg.

Well, there have been no major problems with the basic vital signs, indicating that the renal failure is progressive and has not progressed to the final stage.

"When did it start? Why is it bad?"

Zhao Sheng asked the eldest sister as usual.After hearing Zhao Sheng's words, the eldest sister lowered her head and seemed very reluctant to speak. She looked very regretful and ashamed.

"Say, the doctor is asking you!"

The middle-aged man with glasses standing aside saw the eldest sister silent and looking regretful and ashamed, and said with both distress and anger.

"You say it's okay, but why did she start to be bad?"

Zhao Sheng saw the couple like this, so he said to the uncle.

In the process of seeing a doctor, Zhao Sheng saw too many family conflicts.

This is normal.

As a middle-aged couple, there is an older one and a younger one, and they have to be optimized at the age of 35. Then they go to Didi to take out food and set up a small stall. It is normal to have conflicts.

There is a saying that goes like this, [Middle-aged relationships are not as good as dogs, and when it comes to breaking up, they divide the queen]. When a middle-aged couple's love becomes sour, their relationship becomes thin and watery. Coupled with aesthetic fatigue, life becomes a small wave. Come here and we can sort it out.

The married life of a middle-aged man can be described with this sentence: "My wife and children are calling me, so I pretend to be deaf and hide away". Especially in the eyes of my wife and children, when my husband and father come home, they are in love with each other. He plays with his mobile phone with his feet. When he says something is wrong, he grabs the mobile phone and runs to the toilet. He tries to occupy the bathroom in various ways.

Even the children are confused, why does dad have to poop so many times a day?

Some people ask whether there is pure friendship between men and women. Yes, there is, that is, middle-aged couples.

It can be said that "you and I are not meant to be together, we are all entangled by our children".

"Doctor, she started to have urea blood three days ago. It was dark red at first, then turned into soy sauce color. Then her face and legs swelled up, and she couldn't breathe well."

The middle-aged man with glasses thought for a while and said.

You are angry, but you still need to be treated for illness.

Judging from his accurate description of her condition, he has always been concerned about her condition.

This is much better than some husbands who come to the hospital and don't know anything about everything.

"Urea blood? How about the last two days? How is the urea level?"

As soon as Zhao Sheng heard about the dark red blood urea and soy sauce urea, his expression suddenly became solemn.

This dark red urea is okay, but many situations can cause urea blood, such as urea tract damage and other problems.

But this urea appears soy sauce color, which means that it is mainly hemoglobinuria, and a small part is myoglobin urea. This is because a large number of red blood cells in the body are destroyed, a large amount of hemoglobin enters the blood, and after being excreted through the kidneys, the urea liquid becomes soy sauce color.

"There is no urea since yesterday morning."

The middle-aged man with glasses saw Zhao Sheng's expression suddenly becoming serious and said nervously.

"Have you had any examination before coming here?"

Zhao Sheng asked seriously.

24 hours without urea, which is the main criterion for the diagnosis of acute renal failure.

"I took a blood test. Here is the list."

Seeing the seriousness on Zhao Sheng's face, the uncle quickly took out a report sheet from his bag.

Zhao Sheng took the report and took a closer look. It was a liver and kidney function test. Other things were fine. He looked at the creatinine. Good guy, it was 480 μmol/L!

You should know that the creatinine of normal adult women is generally 70~106μmol/L.

480, which is five times faster!

There is no problem in diagnosing acute renal failure if creatinine suddenly rises without urea for 24 hours.

So the question is, what causes such severe acute renal failure?
(End of this chapter)