Wernicke's encephalopathy is a mental disorder caused by alcoholism. It is a common metabolic encephalopathy of chronic alcohol poisoning. Chronic alcoholism is exacerbated by thiamine deficiency due to long-term alcohol consumption.

Thiamine is vitamin B1, and the main active form in the human body is thiamine pyropholipin (TTP), which is an important cofactor in the transketolase (TK) reaction of the disease dehydrogenase complex (KGDHC) and the pentose phosphate pathway. Cells need a TK reaction to convert glucose into ATP, an energy form that cells can use. It can be said that this substance, which has a total content of no more than 30 mg in the human body, is actually the basis for supporting the vitality of the entire human body. Deficiency of this important cofactor can lead to impaired energy metabolism in the brain and lead to localized lactate buildup.

Vitamin B1 deficiency is a nutritional disease that is more widely known by beriberi. Beriberi was recorded in the Zuo Chuan in 314 BC, when it was described as "addicted to heavy legs". And for 2,000 years, the disease has plagued people. In particular, it was widely popular in the 18th~19th century, when hundreds of thousands of people died of beriberi every year in China, Japan, and Southeast Asia. It wasn't until 1926, when two Dutch chemists discovered and purified vitamin B1 from bran, that beriberi got its real "cure".

Vitamin B1, on the other hand, cannot be synthesized by the body and is a water-soluble vitamin, so it cannot be stored in the body and needs to be replenished daily. Therefore, if the patient does not consume any food containing vitamin B1 for more than 18 days, the patient can develop symptoms of vitamin B1 deficiency. If you are absent for more than three weeks, brain lesions will develop. Long-term lack of vitamin B1, after the patient has systemic lesions all over the body, even if he suffers from "beriberi".

"The main cause of Wernicke's encephalopathy is vitamin B1 deficiency in patients. Sun Lien's neurology department is actually quite good, and he quickly grasped the key point, "If Director Mei suspects that the patient is Wernicke's encephalopathy, give her intravenous vitamin B1 supplements, and see how the patient's condition changes after a quick supplement."

"Patients and their families must be informed before diagnostic treatment. Director Mei shook her head, "This child's parents died early, she has no immediate family, and she ......," she sighed, "She is not married yet." ”

"Does it mean that there is no agent who can make medical decisions for her?" Sun Lien frowned, this situation was the most troublesome and terrifying. When this kind of thing happens alone, doctors can't save people in any way. "And what have you been doing for the past two days?"

Director Mei patted the bed, "If there is no diagnostic treatment, then it can only be diagnosed." But ...... in the courtyard, she stopped suddenly, looked around habitually, and was about to say something after making sure that no one was there, but suddenly stopped. Director Mei paused for a few seconds, and stared at Sun Lien with a strange look for a while, and then suddenly asked, "I heard that your family bought this hospital?"

Sun Lien didn't expect Director Mei to say this, so he nodded and didn't answer.

"That's great!" Unexpectedly, Director Mei grabbed Sun Lien's arm very excitedly, "You quickly ask the imaging department to turn on the MRI, and immediately ask the laboratory department to turn on the machine and check the vitamin B1 concentration in her blood." ”

Sun Lien asked in surprise when he heard this request, "You haven't done any of these inspections?" He tacitly thought that Director Mei had already done all these inspections. The reason for not being diagnosed is that the indicators are normal. But now listening to her senior sister, she didn't do relevant tests for patients at all. I made the diagnosis based on my own experience.

It's not right, it's not right.

"No way...... Our obstetrics and gynecology department has a limited reception capacity, and these contracted auxiliary departments have always ignored us......" Director Mei was obviously a little depressed when she said this topic, "What's more, she doesn't have any family members, and the cost of the examination has not been settled." ”

Sun Lien frowned, in fact, with his current "status", there is no problem at all in asking a certain department of the hospital to start operating again and provide corresponding services. The so-called "department contracting" is in fact an illegal act defined by the National Health Commission. It is not recognized and guaranteed by law, and it must be cleared. In other words, the current paper mill hospital is completely the world of the Sun family.

But the actual difficulty in front of Sun Lien, the second generation of the rich, was that when they came over in the afternoon, the staff of the Health Commission posted a notice of suspension of business for rectification. According to the requirements of the National Health Commission, the paper mill hospital was ordered to suspend business for six months for rectification because it was suspected of arbitraging national social security funds, using unlicensed personnel to carry out diagnosis and treatment activities, and illegally contracting departments.

From the moment the closure notice was issued, the paper mill hospital could no longer carry out any type of medical activity. Imaging tests and blood tests are also included in the scope of medical activities.

"The cost of the inspection is easy to manage, but it doesn't cost much to do an inspection. After all, Sun Lien now has money in his wallet, and he has the confidence to speak, "It's really not good, I can come out personally." But the problem is ......" Sun Lien pointed helplessly to the door, "The notice of suspension of business for rectification has been posted, and now I can't do an inspection if I want to." ”

The two of them fell silent at the same time, and Director Mei looked a little helpless. It's hard to be a doctor in this environment, although I don't know why this Senior Sister Mei chose to be a doctor here all the time, but Sun Lien still wants to help her and help this patient.

"Regarding the diagnosis of Wernicke's encephalopathy in this patient...... Sun Lien first broke the silence and asked, "Your main reason for the diagnosis is because she is showing mental symptoms?"

"When she was sent here, she did have some mental problems. Director Mei replied, "In addition, she also has symptoms of ophthalmoplegia - when she looks at me, the movement of her right eye is out of sync with her left eye. ”

Sun Lien nodded, eye muscle paralysis and mental disorders appeared at the same time, which was indeed consistent with the symptoms of Wernicke's encephalopathy, "It is indeed very likely that Wernicke's encephalopathy." He was pondering which hospital would be more appropriate for Liu Mei to transfer.

"The most important thing is that my family lives fairly close to hers. Director Mei added, "During this time, I met her several times. On two of those occasions, I saw her throwing up badly on the side of the road. ”

This is the main reason for judging Wernicke's encephalopathy. Sun Lien sighed. Severe morning sickness can indeed lead to Wernicke's encephalopathy in pregnant women - they can't eat and vomit, and their nutrition will definitely not keep up. It's just that it's 26 weeks old and there is such a severe morning sickness, which is a bit conflicting with what Sun Lien has learned. Generally speaking, morning sickness is a type of early pregnancy reaction, and some pregnant women will experience severe vomiting in the first trimester due to the rise of HCG (chorionic gonadotropin), decreased gastric acid secretion and prolonged gastric emptying time. However, this reaction usually diminishes or even disappears after 12 weeks of gestation.

"Is there such a severe morning sickness at 26 weeks?" Sun Lien asked with a frown, "She is so serious that she has Wernicke's encephalopathy, should she have a therapeutic abortion?"

Asked this, Sun Lien and Director Mei sighed together. There are no family members, no spouses, and even if the doctors want to save Liu Mei by terminating the pregnancy, no one can sign it, and they have no right to do so.

"I ...... I'd better give you a call and ask. Sun Lien sighed and took out the phone from his pocket, "I don't know if the lockdown of the Maternal and Child Health Hospital has been lifted, but I hope it has been able to accept patients." ”