The Godfather of Surgery

Lactic acidosis causes the body's acid-base balance to be out of balance, which in turn causes electrolyte ion disturbances, resulting in arrhythmia or cardiac arrest.

A 50% chance of dying is about the same as flipping a coin.

Wei Danian has at least one attack every year, which means that his life has to flip a coin between life and death every year. Over the years, he actually got the side he wanted every time.

Do bedside hemofiltration!

The ICU doctor An acted decisively, which was the quickest way to remove excess lactic acid from the blood. At the same time, he will continue to supplement the patient with alkali, and accurately calculate the amount and speed of the supplement.

The amount of alkali supplementation is too large or the speed is too fast, which will cause new problems and cause new electrolyte ion disorders.

The nurse begins to perform arterial and venous puncture to connect the patient to the blood vessel of the hemofiltration machine. If the connection is successful, the blood pump is activated, the replacement fluid and the filtration device are activated, and the blood filtration begins.

Our anticoagulation won't cause massive bleeding at your surgical site? Dr. An asked for Dr. Jin's opinion.

Dr. Jin is very sure: No, there is no problem. Our patients after general anesthesia and artificial joint replacement can be injected subcutaneously with low molecular weight heparin calcium for anticoagulation immediately after surgery to prevent deep vein thrombosis.

That's good! Dr. An was relieved, removing lactic acid, supplementing alkali to correct acid, supplementing fluids to expand volume, and three-pronged axe.

Yang Ping has also been waiting by the side. Several young doctors and interns are asking him some questions. He is very famous in the hospital, and there are no young doctors who do not know him.

For cattle people, they usually only look at them from a distance, but now they get along with each other closely, and a studious doctor will naturally have a lot of questions to ask.

The three-pronged axe seems to be effective. Wei Danian's blood pressure slowly rises, the blood lactate value of the blood drawing review begins to drop, and the blood pH value also rises successively.

The discovery is very timely, and the chance of successful rescue is relatively high. Dr. An saw hope.

What should I pay attention to for the lower limbs undergoing surgery? the nurse asked.

Be careful when moving, you need a special person for a little traction, dressing change and extubation of negative pressure drainage, we will come. Dr. Jin instructed the precautions for nursing.

Director Ouyang kept flipping through the disease course records on the computer: Communicate with the family members well. The family members conceal the medical history and record them clearly in the disease course records.

Lactic acidosis is a rare complication of diabetes. In the past, phenformin (Jingtangling) was used to lower blood sugar, which would induce lactic acidosis. Later, this hypoglycemic drug was eliminated, and lactic acidosis was rare.

How can lactic acidosis occur? Is this patient taking Jiangtangling? It's impossible. All the banned drugs are eliminated. If you want to buy them, you can't buy them. The dose of metformin will not cause lactic acidosis. There must be other reasons.

Dr. Jin loves to learn and think very much. When he encounters such a case, he will naturally not let it go. The patient is gradually stabilized, and he has to find out the reason.

This patient has an attack every year, and it is not impossible to have it again during the hospitalization. It is the right way to find the cause as soon as possible.

Lactic acid is an intermediate product of grape metabolism in the human body. There are three major nutrients in the human body: protein, fat, and sugar. Glucose is a sugar and is also the main energy supply material for the human body. It provides energy in two ways, one is aerobic oxidation. , one is anaerobic glycolysis.

Aerobic oxidation is the main method, the main road; anaerobic glycolysis is the supplementary method, and it is a small road. Whether it is a large road or a small road, it must be decomposed into carbon dioxide and water in the end. Lactic acid is the illegitimate child of glucose.

For the anaerobic glycolysis of the glucose trail to produce lactic acid, the most intuitive experience of the human body is muscle soreness after excessive exercise.

Especially those who do not exercise often, suddenly increase the amount of exercise, and the energy supply generated by the aerobic decomposition of glucose in the human body is in short supply, so they have to start anaerobic metabolism, turn on high horsepower, and replenish energy in an emergency.

At this time, glucose produces an intermediate product, lactic acid, under anaerobic metabolism. A large amount of lactic acid cannot be decomposed into carbon dioxide and water, which accumulates in muscle tissue and stimulates nerve endings in muscles, causing muscle soreness.

Clinicians, especially surgeons, have mostly returned some basic medical knowledge, such as biochemical knowledge about carbohydrate decomposition, to teachers.

Under anaerobic conditions, glucose undergoes glycolysis to generate pyruvate, which is then fermented by lactic acid to generate lactic acid; under aerobic conditions, glucose undergoes glycolysis to generate pyruvate, which generates acetyl-CoA in mitochondria, and acetyl-CoA regenerates After the tricarboxylic acid cycle, carbon dioxide and water are finally generated; it can also pass through the pentose phosphate pathway, and finally carbon dioxide and water are generated. Pyruvate enters the tricarboxylic acid cycle and needs the help of pyruvate dehydrogenase and coenzymes to catalyze. When diabetes and When you are hungry, both pyruvate dehydrogenase and coenzyme are insufficient, and pyruvate cannot walk the road, but can only follow the trail, so the lactic acid in the blood increases.

Yang Ping analyzed it for Dr. Jin, not to mention Lao Jin, Dr. An in the ICU also had a headache when he heard it. Although he usually knew how to diagnose and treat these diseases, these biochemical pathways and the tricarboxylic acid cycle were the same as when he was a student. Things that are nerve-racking are not used clinically after work, so naturally they are all thrown away, otherwise the top of the head will be bald long ago.

Director Ouyang was even more confused, and didn't know what Yang Ping was talking about. On the contrary, the intern who had just graduated could still understand a little bit, but only limited to understanding.

I don't know which link has a problem, and the glucose is forced to take a small road. If you want to find the reason, you can find it from here. Yang Ping wanted to put it more popularly, but he couldn't.

Walking on the big road, copying the small road, and talking about the decomposition of glucose so interestingly, the intern hurriedly took out the booklet and took notes.

We all know that Dr. Yang did a beautiful operation and taught Japanese people how to be human at the academic conference. I didn’t expect that these basic knowledge of biochemistry could be learned so well. The key is to combine it with clinical application.

Should it be a genetic disease? Dr. An guessed based on experience.

You can check in this area, but I'm afraid it's not that simple. If there are so many hospitals, if there is a genetic disease related to glucose metabolism deficiency, it will be found out long ago. Dr. Jin is more cautious.

Dr. Jin is very interested in these intractable diseases. Last time, the metal reactive joint synovitis, the screw was taken out, and the pain that had plagued the patient for several years was relieved. This time he is eager to try again, and wants to cooperate with Yang Ping. Explore puzzles.

In order to be rigorous in medicine, it must be like this, without letting go of any clues, everything should be based on objective evidence, rigorous reasoning and argumentation, and finally unlock the truth.

Let's set up a group and bring in the endocrinologist too. Dr. Jin suggested.

The proposal was immediately approved by Dr. An of the ICU and Lao Qin of anesthesia. They are quite academically motivated. When they are doctors, they are awesome and have a stronger sense of presence.

Director Ouyang didn't want to get involved. It's all about young people. He didn't have that passion and energy, and half of his hair was already white. If he continued with them, the other half could not be saved.

Dr. Jin immediately established a group, named it: Medical Detective Agency, and pulled everyone into it.

The case of Wei Danian has become the target of discussion in this group. Lactic acidosis occurs every year. This case itself is very interesting.

Finding the cause is a huge project that requires a lot of work, and it may not be successful in the end. There are many diseases in the world that are not clearly diagnosed every year, and some of them are diseases that have not yet been diagnosed in the world.

Wei Danian's blood pressure rose, the acid-base balance was gradually corrected, and the coin was thrown to the side he wanted again. Yang Ping came out of the ICU. It was already night. Wei Danian's family was all waiting in the family waiting area outside the gate of the ICU.

Dr. An came out to talk to them about their condition. Wei Danian's father wiped his sweat and said, Doctor, it's been hard work, the child has been like this since he was a child, so we have always lived near the hospital. This time, we moved to the vicinity of your hospital, and we bought a house. Pick the one closest to the emergency department.

It's hard to imagine what it feels like to be rescued like this once a year, not to mention the economic consumption, and need to bear huge psychological pressure. Every time I pull it out of the gate of hell, I don't know when the next time will be.

We didn't dare to go out, for fear that there would be no rescue conditions for the disease on the road. The mother said helplessly.

If that's the case, why are you still hiding your condition? How dangerous. Dr. An accused the ignorant parents.

We also thought, anyway, in the hospital, if he suddenly fell ill, he could be rescued, so we didn't dare to mention his condition. I was afraid that you would postpone the operation and watch the child cry in bed, which would make me uncomfortable. The father smiled awkwardly.

Now the condition has improved slightly, the blood pressure has risen, and we need further observation. We still have to find a way to find the cause. These are all required to be signed by you. Dr. An put a stack of signed documents on the meeting table.

We went to the major hospitals in the Modu and Imperial Capital to see it, but nothing was found. Every time we went out to see a doctor, we were always apprehensive. After getting off the plane, we ran to the hospital. We don't expect to find out the cause, we just hope that he is safe.

Father flipped through these signed documents. He didn't need to read them. He was very familiar with them. He knew how to sign with his eyes closed.