Turbid, gloomy, like a pool of stagnant water.

The moment he met these eyes, John's heart couldn't help but tremble, as if he had returned to the first time he went to the ward for internship in his previous life. At that time, he couldn't see or hear it, especially when he heard the uncontrollable moans of some patients, and he always felt that the ward was like hell. Then, with the internship in his fifth year, the rotation after graduation, the fixed course, and the tempering of countless surgeries, his heart seemed to become as hard as a stone.

But today......

Perhaps it was because of the small, depressing environment, or perhaps because of the lifeless silence in the patient's eyes, John felt his heart touched.

"Mr. Huntelaar, there are six patients in this ward."

As a student of Koch, Kitasato Shibazaburo took the initiative to introduce: "All the patients who have just been admitted in the past two days have symptoms of diarrhea and vomiting, and two of them are in serious condition, and Vibrio cholerae has been detected in their excrement!" ”

"Hmm."

After listening to Kitasato's explanation, John nodded slightly.

During this special period of time, there are symptoms of diarrhea and vomiting, and Vibrio cholerae is also detected in the excrement, which is basically confirmed to be cholera infection. Moreover, in terms of the medical technology of this era, it is superfluous to do more tests or anything, and direct cholera treatment is undoubtedly the most appropriate choice.

However, no matter how sure you are, the necessary tests are still required.

After taking a deep breath, John walked over to the bedside of the two critically ill patients. Let's start with a patient on the left, a white man in his thirties, who looks quite tall. But lying on the bed at this moment, the condition of this middle-aged man is terrifying: his skin is dry and wrinkled, and his eyes are deeply sunken. His pale cheeks were equally sunken, and his expression was indifferent, unresponsive to John's arrival.

"Hmm...... Typical cholera countenance. ”

After just two or three glances, John nodded secretly.

For cholera patients, dehydration is the worst enemy. Medical dehydration refers to the fact that the body consumes a large amount of water, but cannot replenish it. A condition that leads to a metabolic disorder.

Vibrio cholerae is fragile and can be easily killed, even if it enters the body, most of them are killed by stomach acid. But if too much of Vibrio cholerae is ingested, the sea tactics will cause some of them to reach the small intestine. These lucky ones will swing their flagella to rip through the mucus and dense villi of the small intestine. In the "comfortable" environment of the small intestine, Vibrio cholerae multiplies rapidly and secretes a cholera enterotoxin, the main substance that causes various symptoms.

Enterotoxins undergo a complex chemical reaction that acts like a pump to pump water, chloride and bicarbonate out of cells and inhibits the normal absorption of sodium by the small intestine. The end result is a large amount of water and electrolytes that accumulate in the intestinal lumen. It forms a watery sample and is excreted by the patient. It is just such a small Vibrio cholerae that can suck thousands of milliliters of water from the human body in a day, and all of them are made into "rice soup stool" and excreted from the human body. Of course, the simple Vibrio cholerae does not waste energy to produce enterotoxins, and the "rice soup" will carry countless Vibrio cholerae out of the human body and into rivers or urban sewer systems, and if they are lucky, they can find the next unlucky egg......

So for people with cholera, almost all symptoms are caused by dehydration. Like the two critically ill patients in front of John's eyes. It is obviously a case of severe dehydration, and at least 4,000 ml of water has been lost in the past period!

Just as John was carefully observing the two patients. Kitasato Shibazaburo explained: "In the past twelve hours, the condition of the two of them has deteriorated rapidly, and there is almost no urine ......"

"Hmm."

While nodding unconsciously, John didn't hesitate too much, and looked directly at Koch, who had been following him: "Professor, please call two students." Follow Mr. Ehrlich to help prepare rehydration, they are all in serious condition and must be rehydrated immediately! ”

"No problem!"

Koch didn't hesitate either, and simply waved his hand at Kitato.

After receiving Koch's order, Kitasato immediately trotted out to find someone. John's theory of cholera treatment. The most important thing is undoubtedly to give the patient fluids and electrolytes, and of course they know this very well. And the reason why I brought them to the ward today is to verify the correctness of this treatment theory, if it really works for cholera patients......

Ignoring Kitasato, who had run out, John continued to examine the patient.

He could now be sure that the patient had cholera, but as a physician, he had to follow up on the tests. Reached out and pressed the skin on the other's arm, without any elasticity; After examining the gastrocnemius and rectus abdominis muscles, the tonia is very obvious; Severe muscle tone loss, and hypokalemia symptoms such as bulging intestine are prominent; Breathing quickened, consciousness was noticeably impaired, and his limbs were cold and his pulse was so rapid that he could barely reach it......

"Hmm, Professor, do we have a blood pressure monitor?"

After a busy moment, John looked up and asked.

"Yes, yes!"

Koch motioned for a physician in the ward to bring a blood pressure monitor, and John took it and looked at it, and was immediately happy - it was still a product of Heinz Medical Devices!

After measuring his blood pressure, John finally straightened up: "Okay, the blood pressure has dropped sharply, I can already confirm it." ”

"Oh?"

Blinking, Koch had a slight doubt in his eyes. In his opinion, this is really nothing to check, what else can it be if it is not cholera? He didn't quite understand what John was going to do with all this effort, so why didn't he just start the treatment?

Ignoring Koch's doubts, John went on to give a full examination to several other patients.

Cholera patients are in severe condition and progress very rapidly, but without proper examination, it is impossible to determine the appropriate treatment plan. It is important to know that rehydration is not arbitrary, and the patient's condition must be strictly judged, and the final choice is whether oral or intravenous rehydration is used - oral or intravenous rehydration for mild and moderate, and intravenous rehydration for severe cases. Of course, there were some peculiarities, but in this day and age John decided to ignore them.

By the time the six patients were examined, it was already more than half an hour later.

Because Koch had prepared glucosacrose, sodium chloride, sodium bicarbonate and ****** in advance, as well as the latest intravenous infusion kit from Heinz Medical Devices, an hour and a half later, Ehrlich and Kitasato Shibasaburo were ready.

Fluids are simple to configure, whether orally or intravenously.

The oral rehydration solution is 20 g of glucosaccharide, 3.5 g of sodium chloride, 2.5 g of sodium bicarbonate, 1.5 g of ******, dissolved in 1000 ml of water, and the electrolyte concentration is equivalent to the excretion concentration. Because there were no children this time, John didn't need to be given special rehydration fluids. As for intravenous rehydration, it is not complicated, 550 ml of 0.9% sodium chloride, 300 ml of 1.4% sodium bicarbonate, 10 ml of 10% ******, 140 ml of 10% glucose, and 1000 ml of rehydration solution.

After everything was ready, Kitasato Shibazaburo asked respectfully, "Mr. Huntelaar, I would like to ask, who are you...... How are these liquid components determined? ”

Hearing this, Ehrlich and Koch's eyes looked at each other at the same time.

"Hehe, in fact, someone has already raised it."

John's face remained unchanged, but he shrugged his shoulders and said, "Remember that Italian Mr. Pasini?" He had studied cholera all his life, and had long since proposed that patients should be hydrated according to the composition of watery stools, based on the characteristics of autopsies......"

"Uh......"

After hearing this answer, everyone was stunned.

The truth, it's that simple?

"Yes, it's that simple!"

Nodding, John silently mourned for Mr. Pasini. It is said that most artists can only be recognized after they die, for example, Van Gogh and other people, when he was alive, his works were not cared for, and when he died, how high the price of his paintings was? But in John's opinion, such a scientist is even more pathetic! Pasini's research in the field of cholera was decades ahead of the rest of Europe, but when he was alive, he was not recognized at all, and even the discovery of Vibrio cholerae was pinned on Koch's head. It wasn't until decades later that Pasini's theory was widely recognized, and it was discovered that he had long since proposed the theory of rehydration......

"In that case, let me bring this process forward!"

After taking a deep breath, John said in a deep voice: "Gentlemen, let's start the treatment, three people who are slightly ill will be given oral rehydration, and three people who are seriously ill will be given intravenous rehydration!" Mr. Ehrlich is in charge of oral rehydration, which is administered to the standards I have set, and I will personally administer the intravenous rehydration......" (To be continued. )