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

A 50% mortality rate is about the same as a coin toss.

Wei Danian had at least one seizure every year, meaning that his life had to be tossed once a year between life and death. For so many years, he actually got the side he wanted every time.

"Perform bedside hemofiltration!"

Dr. An in the ICU immediately decided that this was the fastest way to remove excess lactic acid from the blood. At the same time, he has to continue to give the patient alkali supplementation, accurately calculating the amount and speed of alkali supplementation.

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

The nurse begins to perform arteriovenous puncture, so that the patient is connected to the vascular path of the hemofiltration machine, the connection is successful, the blood pump is started, the replacement fluid and filtration device are activated, and the hemofiltration begins.

"Our anticoagulation doesn't cause heavy bleeding at your surgical site, does it?" Dr. Ann sought Dr. Kim's advice.

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

"That's good!" Dr. An was relieved, removing lactic acid, supplementing alkali and correcting acid, rehydrating and expanding, and splitting the three-plate axe in the past, and it was necessary to observe whether it would work.

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 just look at it from a distance, but now they get along at close range, and studious doctors naturally have a lot of questions to ask.

The three-plate axe seemed to be effective, Wei Danian's blood pressure slowly rose, the blood lactate value of the blood retest began to drop, and the pH value of the blood also increased one by one.

"The discovery is very timely, and the chance of successful rescue is relatively large." Dr. Ann saw hope.

"What should I pay attention to when I have surgery on my lower limbs?" The nurse asked.

"Be careful when moving, you need a little traction, dressing change and negative pressure drainage extubation, we will come." Dr. Kim directs the dos and don'ts of nursing.

Director Ouyang kept flipping through the medical records on the computer: "The communication with the family members is done well, and the family members conceal the medical history and record it clearly in the medical course records." ”

Lactic acidosis is a rare complication of diabetes, and in the past, phenformin (hypoglycemic medicine) was used to lower blood sugar, which could induce lactic acidosis, but later this hypoglycemic drug was eliminated, and lactic acidosis was rare.

"How can lactic acid poisoning? Is this patient taking hypoglycemic drugs, impossible, all the banned drugs are eliminated, you can't buy them if you want to, the metformin treatment dose will not cause lactic acidosis, there must be other reasons. ”

Dr. Jin loves to learn and think, and when he encounters such a case, he will naturally not let it go, and the patient is gradually stable, and he has to find out the cause.

This patient has seizures every year, and it is not impossible to have another attack during the hospitalization, and 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, and the human body has three major energy substances: protein, fat, and sugar, glucose belongs to sugars, or the main energy supply substances of the human body, it provides energy in two ways, one is aerobic oxidation, and the other is anaerobic digestion.

Aerobic oxidation is the main way, which is the avenue; Anaerobic glycolysis is a supplement method, a small road, whether it is a big road or a small road, it will be decomposed into carbon dioxide and water in the end, and lactic acid is the illegitimate child of glucose on the small road.

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

Especially for those who do not exercise regularly, the amount of exercise is suddenly increased, and the energy supply generated by the body's glucose aerobic decomposition mode 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, and a large amount of lactic acid does not have time to decompose into carbon dioxide and water, which accumulates in muscle tissue, stimulates the nerve endings in the muscles, and causes muscle soreness.

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

"Under anaerobic conditions, glucose is glycolyzed to produce pyruvate, and then lactic acid is fermented to produce lactic acid; Under aerobic conditions, glucose is glycolyzed to produce pyruvate, which generates acetyl-CoA in mitochondria, and acetyl-CoA then passes through the tricarboxylic acid cycle to finally produce carbon dioxide and water. It can also pass through the pentose phosphate pathway, and eventually produce carbon dioxide and water. When diabetes and hunger, pyruvate dehydrogenase and coenzyme are insufficient, and pyruvate can not go the big way, but can only copy the path, so the lactic acid in the blood increases. ”

Yang Ping analyzed it to Dr. Jin, not to mention Lao Jin, Dr. An in the ICU also had a swelling pain in his head when he heard it, although he usually knew how to diagnose and treat these diseases, what biochemical pathways, and what tricarboxylic acid cycles, it was a nerve-wracking thing when he was a student, and he couldn't use it clinically after work, so he naturally threw it all away, otherwise the top of his head would have been bare.

Director Ouyang was even more foggy, and he didn't know what he was talking about, but the interns who had just graduated could still understand something, and only understood it.

"I don't know which link went wrong, so I forced the glucose to take a small path, and if I want to find the reason, I will find it from here." Yang Ping wanted to put it more in layman's terms, but he couldn't.

Take the big road, copy the small road, and talk about the tricarboxylic acid cycle so interestingly, the intern hurriedly took out a booklet and took notes.

Everyone knows that Dr. Yang did a beautiful job in surgery, and taught Japanese people how to be human beings at academic conferences, but I didn't expect that these basic biochemical knowledge were learned so well, and the key is to combine them with clinical application.

"Is it a genetic disease?" Dr. Ann guessed empirically.

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

Dr. Jin is very interested in these incurable diseases, the last time the metal-reactive joint synovitis was removed, and the pain that had plagued the patient for several years was relieved, and this time he was eager to try it again and wanted to cooperate with Yang Ping to explore the problem together.

If medicine is to be rigorous, it must be like this, not letting go of clues, everything is based on objective evidence, rigorous reasoning and argumentation, and finally unraveling the truth.

"Let's set up a group and bring in the doctors from the endocrinology department." Dr. King proposed.

The proposal was immediately approved by Dr. An in the ICU, anesthesia Lao Qin, they are quite academically motivated, they are a doctor, they are a little awesome, and their sense of existence is stronger.

Director Ouyang didn't want to get involved, this was all a matter of young people, he didn't have that passion and energy, half of his hair was already white, and if he continued to engage with them, the other half would not be able to be saved.

Dr. Kim immediately set up a group, named it: Medical Detective Agency, and pulled everyone in.

Wei Danian's case became the target of discussion in this group, and lactic acid poisoning occurs every year, which is very interesting in itself.

Finding the cause of the disease is a huge project, which requires a lot of work, and in the end it may not be successful, and 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 gradually corrected, and the coin was once again tossed to the side he wanted. When Yang Ping came out of the ICU, it was already night, and all Wei Danian's family members were waiting in the family waiting area outside the ICU gate.

Dr. An came out to talk to them about the condition, and Wei Danian's father wiped his sweat and said, "Doctor, it's hard work, the child has been like this since he was a child, so we have been living near the hospital. ”

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

"We didn't dare to go far away, for fear that there would be no rescue conditions for illness on the road." Mother said helplessly.

"In that case, why are you still hiding your illness? How dangerous. Dr. Ann blamed the ignorant parents.

"We also want to be in the hospital anyway, if there is a sudden onset, we can be rescued, so we didn't dare to mention his condition, for fear that you would postpone the operation and see the child lying in bed and screaming." The father smiled awkwardly.

"Now that the condition is slightly better, the blood pressure has risen, and we need to be further observed, and we have to find a way to find the cause of the disease, which requires your signature." Dr. Ann placed a stack of signed paperwork on the table.

"We went to the big hospitals in the magic capital and the imperial capital, but we didn't find any disease, and every time we went out to see a doctor, we were also scared, and we ran to the hospital as soon as we got off the plane, we didn't expect to find out the cause of the disease, we just hoped that he was safe."

My father flipped through these signed documents, he didn't need to look at them, he was very familiar, and he knew how to sign them with his eyes closed.