"After being admitted to the hospital, the three major routines and the full set of biochemistry were normal, and the test results of the three thyroid functions were also normal."

"At present, the hormones used by patients are prednisone 40 mg once a day and brobistigmine 60 mg once a day, four times a day."

"The problem now is that the patient's diarrhea is uncontrollable, reaching more than 10 times a day, watery stools, not much each time. Since we could not control the patient's symptoms, I asked Dean Lin to come back and guide us in the next step of diagnosis and treatment. ”

Dong Huayu's report is focused and there is not much nonsense.

"Dr. Dong's report was very detailed, and we were concerned that if the diarrhea was not controlled, the patient's nutritional status would deteriorate, and there was a high risk of another myasthenic crisis." Zhuo Yiming added.

"Okay, let's go see the patient." Seeing that no one was adding, Lin Lin stood up. At this time, he didn't want to waste any time.

Under the guidance of Ding Feng, he came to the ward. This is the first time that Lin Lin has come back for rounds after the new ward was completed and put into use.

Looking at the clean, bright and well-equipped ward, Lin Lin felt very happy and relieved in her heart.

As soon as Lin Lin stepped into the room where the patient was, she immediately shouted, "Brother Shi, why are you here?" ”

It turned out that what Lin Lin saw was Brother Shi from Shishan Village.

"My sister was sick, and at my insistence, she was transferred from the People's Hospital."

"Ah, is it Sister Shujing?" Lin Lin looked at the hospital bed. Shi Shujing, who was reclining on the bed, smiled at Lin Lin and nodded.

"Brother Shi, why are you here now? Sister Shujing's situation, I have already heard the report just now, and it is indeed a bit complicated. ”

"Alas......" Shi sighed, his eyes fixed on his brother-in-law Xie Long who was standing beside the bed. At this moment, the stone exuded a fierce aura all over his body, as if it was about to tear Xie Long to pieces.

"I'll take a look and try to adjust Sister Shujing's situation as well as possible." Lin Lin realized that the problem was Xie Long.

"Sister Shujing, what do I ask, what do you answer, I don't ask, you don't need to say. In your current situation, it will be very difficult to talk too much. Shi Shujing listened and nodded.

"Have you started to adjust the amount of hormones and pyridostigmine bromide in the last month?"

"Yes, yes."

"Is it the same as the two medicines?"

"Yes."

"Why do you want to mix medicine?"

"Recently, I felt that my strength was a little poor, and when I went to the People's Hospital for a follow-up visit, my doctor in charge adjusted the medication for me."

"What was your original amount?"

"The hormone is six tablets a day in the morning, and pyridostigmine bromide is one tablet three times a day."

"Is your current situation related to this adjustment?"

"Yes, after adding a large amount, the strength is a little better, but the diarrhea is obvious."

"Is your diarrhea noticeable at night or during the day?"

"It's noticeable during the day, especially after eating."

"Okay, I see, I'll check." In the past ten years, the beautiful Shi Shujing has become unrecognizable. There is only a pair of beautiful eyes left, telling Lin Lin that she is Shi Shujing back then.

Lin Lin did not let Shi Shujing do a fatigue test, for this kind of patient with a clear diagnosis, Lin Lin did not want to increase the patient's pain. Lin Lin took the stethoscope given to him by Ding Feng and listened carefully to the patient's abdomen, and sure enough, the bowel sound was very active.

Lin Lin touched the patient's abdomen and limbs with her hands again, and there was a feeling of "wetness". At this moment, Lin Lin already knew it.

"Brother Shi, Sister Shujing, Brother Xie, in a while, we will discuss Sister Shujing's condition, and next, please ask Sister Shujing to take medicine according to our plan. If there is a situation, report it to Dr. Dong or the doctor on duty at any time, don't be embarrassed. ”

Hearing this, Shi breathed a long sigh of relief, stretched out his hand, and held Lin Lin's hand tightly.

"Dr. Lin, I haven't seen you for more than ten years, let's see when you're free, let's talk."

"Let's find a time, this is Director Ding, Brother Shi has a problem, you can ask Director Ding for help at any time. By the way, Brother Shi, tell me, your mobile phone number, I'll dial it, you and I will keep it all in it, if you have something, you can also find me directly. ”

"Okay." When Shi heard this, he immediately told Lin Lin his mobile phone number. Lin Lin dialed the number according to the stone said, and the two of them collected each other's mobile phone numbers.

Back in the office, everyone sat down, and Lin Lin spoke.

"Everyone talks about their opinions and speaks freely, and I want to hear your thoughts."

"I'm the doctor in charge, so I'll start with my superficial opinion." Dong Huayu spoke first.

"There is no doubt about the diagnosis of this patient, the key is how to adjust the medication to control the diarrhea."

"The patient's current condition should be related to pyridoxamine bromide overdose. Abdominal pain, diarrhoea, and sweating are all precursors to a typical cholinergic crisis and can be very dangerous if not managed properly. ”

"What puzzled me was that the patient was taking the medication because he was unable to get worse. After adjusting the medication, the patient's weakness did improve. If we reduce the amount of pyridostigmine bromide, will there be a further increase in weakness? ”

"So far, I haven't encountered this situation and can't give a good solution." Dong Huayu is very honest.

"I agree with Dr. Dong's opinion. Whether to reduce hormones and pyridine's mine at the same time, or to reduce hormones or pyridinestigmine bromide first. I don't dare to give a definite answer, however, I prefer to reduce pyridoxamine bromide. Zhuo Yiming's attitude is relatively clear.

"I also agree with Mr. Zhuo's opinion, but how to reduce it and how much it is a problem." Ding Feng rushed in front of Ling Xiaoyun to express his position.

"I agree with Dr. Zhuo and Director Ding. To be honest, this kind of patient is very sensitive, and the reduction of drugs is a great test of our doctor's judgment and observation. Therefore, once the decision is made to adjust the medicine, Dr. Dong and the doctor on duty must closely observe the changes in the condition. "Ling Xiaoyun is still quite experienced.

"I am of the same opinion, that pyridostigmine bromide should be reduced first. Since the diarrhea is obvious during the day, it is better to start reducing it during the day, so that if there is a change in the condition during the day, it is easier to deal with it. Ye Xiu's opinion is more specific.

"Everyone's opinions are basically the same, and I also agree with the direction of this drug reduction."

"Myasthenia gravis, is an autoimmune disease that affects the quantity and quality of cholinergic receptors in the neuromuscular postsynaptic membrane."

"Immunosuppressant treatment is indispensable. As long as there is an autoimmune reaction in the patient's body, it cannot be stopped. ”

"Of course, the best way to do this is to reduce the hormone to the optimal maintenance amount. However, it is not what this patient has to think about now. ”