"The patient has small stones, but the stones do not interfere with urination." Director Liu said with certainty, "Director Xu, I don't think the kidney function is particularly bad, why don't you try dialysis for a few days." ”

"I just don't know why." Director Xu of the Department of Nephrology frowned and said, "I know it has nothing to do with you, but ......"

She spoke, pausing her conversation.

This consultation is indeed a bit nonsensical, but Director Xu has no choice but to give it a try and see if Director Liu of the Department of Urology has any ideas.

"It's none of our business." Director Liu smiled and repeated.

As soon as the words fell, Director Liu suddenly felt that his foot was lightly kicked.

It's Ji Xiang!

He's reminding himself!

Director Liu was stunned and realized that there might be a problem, and immediately recalled the patient's imaging data, past history, and current targeted treatment.

There's nothing wrong with that, this patient has nothing to do with urology!

But he remained silent, got up and said, "That's it for now, I'll go back and think about it." ”

"Thank you Director Liu, please write a pen for the consultation."

"yes, okay."

Director Liu and Ji Xiang left the Department of Nephrology, and as soon as Director Xu's figure disappeared, Director Liu immediately asked, "Xiao Ji, what do you think?" ”

"Director, the patient is using ceftriaxone at the local hospital." Ji Xiang whispered.

"Ceftriaxone? There's nothing wrong with it, broad-spectrum antibiotics have an effect on Staphylococcus aureus, Streptococcus, and Pseudomonas aeruginosa. At that time, the medication was considered symptomatic. ”

Director Liu still didn't know what Ji Xiang was going to say.

"Director......" Ji Xiang didn't know what to say.

"Xiaoji, if you have something to say, you don't have to think that I'm the director." Director Liu raised his head slightly, looked at Ji Xiang and said seriously.

"The drug label for ceftriaxone mentions the possibility of extremely rare gallstones."

"......" Director Liu was stunned, he didn't know anything about it.

Ceftriaxone sodium is a commonly used clinical drug with a very good effect, but can this drug still form gallstones?

Director Liu was stunned.

"Theoretically, ceftriaxone sodium has a high solubility of the drug and is not easy to form urinary tract stones.

Drug concentrations peak for a short period of time when blood volume decreases, urine flow velocity decreases, and when drugs are used in large doses.

Ceftriaxone ions and calcium ions in the urine form ceftriaxone calcium, because ceftriaxone calcium is insoluble in water, and then crystals are precipitated in ureteral urine to form pseudostones, resulting in acute urinary tract obstruction, and then acute renal failure. (Note)

Ji Xiang retold the theory that the system NPC told him 1510.

In fact, Ji Xiang is not very sure, the theory of system NPCs is too bizarre, and kidney failure can be achieved with antibiotics, and Ji Xiang does not understand it very well.

Director Liu was stunned when he heard this.

But Director Liu had already knelt early, starting with a cavernous puncture, and then the unbelievable cases made Director Liu unable to question it.

"How is it diagnosed?" Director Liu frowned and asked.

"Animal experiments and in vitro experiments have shown that the formation of ceftriaxone stones is positively correlated with the concentration of calcium ions in urine and ceftriaxone, and negatively correlated with the concentration of citrate in urine."

"But if you check it, I'm afraid that we don't have the Second Affiliated Hospital, so I'll take a look in the mirror."

Ji Xiang suggested.

"Okay." Director Liu turned around, hesitated for a moment and picked up his phone.

"Lao Gao, I, Liu Zhi, you can help me take a look at the instructions for ceftriaxone."

"Why just talk so much, I may have a problem patient on my side."

"It's not allergies, I don't know about that. Take a look at the ceftriaxone instructions to see if it says it causes gallstones. ”

Director Liu was not embarrassed to question Ji Xiang's statement, he held his mobile phone and waited for the director of the pharmacy department to reply.

Ceftriaxone sodium is not metabolized in the body, 60% is excreted by the urinary system, and 40% is excreted by the biliary tract and digestive tract.

If the gallbladder can form stones, then the urinary system can too, but it's quite rare.

So he cautiously asked the director of the pharmacy first.

Soon, the phone rang, and the director of the pharmacy on the other side seemed surprised, and his voice was a few decibels louder.

Director Liu's orbicularis oculi muscle twitched a few times.

"I see, thanks."

Hanging up the phone, Director Liu looked at Ji Xiang in surprise.

"Xiao Ji, have you read all the drug instructions? And can you memorize it? ”

Ji Xiang was a little ashamed, where he would, it was all opened by the system NPC.

Seeing that Ji Xiang's expression was different, Director Liu raised his hand with a smile and patted Ji Xiang's shoulder.

"That's a good thing, and I'm not jealous. Xiao Ji, I'll be a mirror with you for a while. ”

"Okay Director."

Director Liu no longer hesitated, turned around and went back to find Director Xu.

"Director Liu, why are you back? Did you drop something? Director Xu of the Department of Nephrology was stunned.

"Xiao Ji reminded me, I suddenly remembered something."

Director Liu "translated" Ji Xiang's words again, although there were some deficiencies, but Director Xu of the gods could understand them.

"Director Liu, why haven't I heard of it?" Director Xu questioned without hesitation.

"Be prepared to be a mirror, take a look, and see at a glance whether anything is going on or not."

"Make a mirror?" Director Xu was stunned, she didn't understand why she wanted to make a mirror.

"Director Xu, you haven't been diagnosed, I don't know what's going on, I suggest a possibility that you still don't believe it." Director Liu suddenly lowered his face, "If you don't want to, I'll go back, I'm tired from a day of surgery, who wants to go to the mirror in an emergency." ”

"Don't mind!" Director Xu immediately smiled, "Director Liu, look at you." I just don't understand, why are you still angry. Usually you don't do that, don't be stingy. ”

She was going to take the patient to the urology department to check the information.

After using ceftriaxone for so many years, Director Xu, like Director Liu, did not know that there was still the possibility of forming stones.

"Director Liu, is there any other way to diagnose?" Director Xu asked casually.

"Xiao Ji, you say." Director Liu was proud.

"The most reliable way to confirm the diagnosis of ceftriaxone stones is infrared spectroscopy, but our Second Affiliated Hospital has not carried out such examinations.

The diagnosis should be based on the patient's medical history, and when the patient develops symptoms of renal colic after recent ceftriaxone sodium use, combined with sudden oliguria or anuria, the possibility of acute postrenal renal failure caused by ceftriaxone stones should be considered first. ”

"It's unlikely, but it happens occasionally."

“……”

When Director Xu heard Ji Xiang's explanation, his whole person became uncomfortable.

Ji Xiang said it too professionally, and he didn't understand it, which made Director Xu a little embarrassed.

……

……

Note: Ceftriaxone causes gallstones was written in the early days of the live broadcast room, but I didn't know that it could also cause kidney lesions, and I was surprised when I turned to the paper.

Source: Journal of Clinical Urology, Issue 3, 2015.