Although it is now a society governed by the rule of law, there are too many people who take risks for the sake of great profits.

There have been incidents where the actress was kidnapped by gangsters and then hurt in various ways.

Su Qianqian is like a mirror, Zhou Can will never allow her to be broken.

"Got it! I'm not a three-year-old, so I'm going to be extra cautious. But I am very touched and happy that you care about me so much! (smiley)"

After chatting with her, Zhou Can waited for Wei Fang's arrival.

Some people may not believe it, but if you have money these years and give favors, you can really buy the loyalty of your subordinates.

Wei Fang was so depressed that he didn't even have money to see a doctor.

If it weren't for Zhou Can's huge amount of money to help her treat her illness, her fate would be completely different from what it is now.

She is a woman who came out of the mountains, and she knows how to be grateful more than a woman who grew up in the city.

Now Zhou Can has given her a very well-paid and stable job, so that she can honor her grandmother who raised her. Let her and her grandma experience the wonderful life of the big city.

Her gratitude and loyalty to Zhou Can is directly reflected in her actions.

dutifully protected Su Qianqian for Zhou Can, and so far, there has been no mistake.

To deal with Hu Wei this time, Zhou Can needs Wei Fang to implement the dark link.

……

After eating, Zhou Can should spend the afternoon in the interventional operating room and inpatient department without accident.

was busy until more than four o'clock in the afternoon, and Director Shang left in a hurry.

Zhou Can came out of the operating room and went back to the ward to deal with the twelve patients in charge at hand.

I thought that managing 11 patients was already the limit.

Unexpectedly, Director Shang saw that he was still comfortable managing so many beds, so he added another bed to him.

Moreover, almost all of the patients assigned to him are patients with incurable diseases or high-risk patients admitted to the group.

There is a teacher who looks down on him so much, what else can Zhou Can say.

You have to resist it with tears!

However, even though he was in charge of 12 inpatients at the same time, and often needed to sit in and undergo surgery, he still did not find it very difficult.

Instead, the most time is spent on writing medical records and course of illness, and discharging patients.

As for the errands such as getting the results of the examination for the patient or sending the documents to the medical department for signing, he was never arranged.

He had just finished reviewing the twelve patients in his care and made appropriate adjustments to the medical orders of some of them.

I sat down in the office and was about to take a breath, when someone came to the door.

"Doctor Zhou, are you busy now?"

Huang Liang, who used to look down on Zhou Can, now sees him with a smile on his face.

Strength is really a good thing, it can convince these arrogant opponents and lick him with the most flattering smile.

"Doctor Huang is in trouble?"

Zhou Can knew that this guy had nothing to do but go to the Three Treasures Palace, and now he came to the door with a shy face, he must have something to ask for.

"Hmm...... That's right, my teacher, Director Zheng, is sitting in the outpatient clinic, and I am a little uncertain about a difficult case, and Director Shang is not in the hospital, so I want to ask you to help me with the staff. ”

Director Zheng is also a well-known expert in gastroenterology.

However, in terms of fame, it is not as good as Director Shang.

The level of diagnosis and treatment is a matter of opinion from the benevolent and wise.

Being able to make Director Zheng pull down his face and personally send someone over to invite Zhou Can to go over as a 'staff officer' is enough to show that Zhou Can's status in the Department of Gastroenterology has really gone up.

Director Zheng will only take action if he feels that he can help him solve the problem by showing his old face and inviting Zhou Can over.

I believe that Director Zheng must have thought about it many times before sending Huang Liang over to invite Zhou Can.

"I'll go with you right away."

Zhou Can drank two sips of water, stood up and left.

Director Zheng personally sent someone to invite him, and this face must be given.

followed Huang Liang straight to the No. 2 special needs specialist outpatient room of the outpatient clinic, and the two walked in directly.

"Hello Director Zheng!"

Zhou Can lowered his posture and took the initiative to say hello.

It is said that giving roses to people leaves a lingering fragrance in their hands.

Even if he was invited by Director Zheng to help, Zhou Can still fully took care of Director Zheng's face.

Take the initiative to say hello, that's the best respect.

"Doctor Zhou is here, please come and sit!"

Director Zheng smiled and beckoned Zhou Can to sit down.

Zhou Can was not polite in front of his family members and patients, and sat down directly next to Director Zheng.

The other two young doctors stood there watching, smiling kindly at Zhou Can.

His eyes were clearly filled with envy and friendliness for Zhou Can.

"This patient had been experiencing frequent stomach pain a year ago, and the symptoms were relieved after a bowel movement. Until a month ago, the patient suddenly had diarrhea and diarrhea, and had watery bowel movements. At most, you can have diarrhea more than ten times a day, and the average number of diarrhea per day will not be less than five times/day. In the last week or so, the patient has taken antidiarrheal drugs, and the symptoms have worsened instead of alleviating. In addition to diarrhea, symptoms of thirst, polydipsia, polyuria, and large urine output appeared. ”

Diarrhea is the most likely to cause dehydration in the body.

In particular, prolonged diarrhea is unbearable for anyone.

When the body is thirsty and needs to drink a lot of water, it has become a normal reaction.

"The patient's weight was lost by more than ten pounds in a very short period of time, and there was occasional flushing on the front chest, which lasted for about ten minutes and disappeared."

According to Zhou Can's diagnosis and treatment experience, the patient's weight plummeted by more than ten catties in a short period of time, which is a serious problem.

It is often a sign of a serious illness.

"Is that him?"

Zhou Can raised his eyes to look at the patient sitting there, and the family member should be the patient's mother. She was a woman of about fifty years of age, with tanned skin, thick bones in her hands, and the skin on the back of her hands looking very rough.

This is a woman who is miserable.

"Yes, yes, my son is sick, please ask the doctor to bother." The patient's mother was the kind of honest woman who did not look down on Zhou Can because she was young, but also showed respect and courtesy.

On the contrary, the young patient himself does not seem to have much hope for Zhou Can.

Understandable.

After all, Zhou Can is very young. Even a little younger than this patient.

"Have you checked your physique?"

Zhou Can asked Director Zheng.

The admission physical examination actually covers a lot of information. Including the patient's medical status, whether it was lifted or walked, as well as the measurement of body shape, basic vital signs, etc.

Visually, the patient's body was emaciated, but not frighteningly thin.

Zhou Can has seen some patients in the intensive care department, and they are so thin that only a skin and bone are left, which is really scary.

"It's been checked. The patient's physical examination data, as well as the chief complaint, medical history and other information are all recorded on it. ”

Director Zheng showed the medical record book to Zhou Can.

The patient was admitted to the hospital for physical examination, slightly emaciated, conscious, and had normal blood pressure, breathing, and pulse. There are no abnormalities in the heart and lungs, the abdomen is soft on compression, and no obvious mass is palpated. Abdominal mobility dullness, no edema of the lower extremities.

Some people with severe diarrhea may experience tight abdominal muscles, or abdominal bloating, fluid accumulation, etc.

When compressed, the abdomen of this group is more often hard.

The patient's abdomen is soft and can be used to rule out many causes immediately.

Zhou Can continued to look at the tests that the patient had done.

Laboratory tests done in other hospitals include blood routine, urine routine, stool routine, and blood biochemical tests.

There are quite a lot of investigations, but the overall data of the patients did not find any obvious abnormalities.

Glucose, protein, and microscopic tests, including urinalysis, were normal. Only the specific gravity is lower, only about 1.0004.

The patient's stool routine in other hospitals, bacterial culture, and Sudan staining were all negative.

Eventually, the major hospital gave a diagnosis of 'functional diarrhea'.

At the same time, because of the patient's clinical manifestations of polydipsia, polyuria, and low specific gravity urine, the patient is suspected to have diabetes insipidus.

When it comes to diabetes insipidus, it is divided into three types, central diabetes insipidus, renal diabetes insipidus, and psychogenic polydipsia.

The patient's clinical manifestations were hypokalemia, and the serum potassium test ranged from 2.2 to 2.8. So the diagnosis given by this big hospital is nephrogenic diabetes insipidus?

A question mark is to suspect that the patient is likely to have renal diabetes insipidus caused by hypokalemia, but the attending doctor is afraid of being slapped in the face and is not 100% sure.

Therefore, putting a question mark means waiting for further verification.

This large hospital has made a statistic on the 24-hour urine output of patients, which is as high as 11,000ml of urine output.

This is a rather appalling amount of urine, a bottle of mineral water 550ml, the patient can excrete urine in a day to fill 20 bottles of mineral water.

In order to find out the cause of the patient's hypokalemia, the large hospital conducted a potassium balance test on the patient, and made the patient fast for three days, and intravenously dripped 3g of potassium chloride every day.

On the third day, blood potassium, urine potassium, and fecal potassium were rechecked, and blood K3.3mmol/L. Urine K14mmol/day, fecal K32mmol/day.

The day is 24 hours.

A normal person consumes 100 mmol of potassium per day, and the gastrointestinal tract can almost completely absorb the potassium ingested.

The kidneys are the main organs that regulate the potassium balance in the body, and about 90% of the potassium is excreted from the kidneys.

A normal person's fecal potassium intake is less than 10%.

This patient was significantly more than three times over-the-top, which can indirectly prove the patient's renal insufficiency.

There are only a few causes of hypokalemia, such as insufficient potassium intake, excessive loss of vomiting, or transfer of potassium ions from outside the cell to inside the cell.

This patient did not have vomiting symptoms except for diarrhea, which can be ruled out first.

Then, the patient's diet is generally normal, and insufficient potassium intake can also be ruled out.

In the end, there is only a third possibility, which is the transfer of potassium ions from outside the cell to the inside of the cell.

There are four most common causes of intracellular and extracellular potassium balance.

First, acid-base balance. Second, insulin. Third, blood aldosterone. Fourth, sympathetic activity.

This disease is simply a big test of human internal science, no wonder Director Zheng needs to invite Zhou Can to help.

He didn't know that Zhou Can's diagnosis was very powerful, but his medical skills were far from being profound.

In the past two years, I have made up a lot of basic medical knowledge, so that I can barely eat in this case analysis.

In order to find out the cause of the patient's intracellular and extracellular potassium balance, Zhou Can re-examined the patient's multiple examination data.

After layers of investigation, he finally diagnosed that the patient should be the first condition, hypokalemia caused by acid-base balance factors.

More precisely, it should be alkalosis.

[Pathological diagnosis +1.]

[If you diagnose a complex pathological mechanism with strong reasoning for the first time, you will be rewarded with +100 for pathological diagnosis.] 】

This is the first time he has been rewarded with experience points and high experience points for pathology diagnosis without diagnosing the final complete cause.

Diagnosing this case is also very beneficial to Zhou Can.

Activate a lot of basic medical knowledge he has learned and use it in practice.

"Did Dr. Zhou find out something?"

Director Zheng did not urge him, but was worried that his family and patients would be left aside for too long, and he was dissatisfied.

It is more or less necessary for the family to see that the doctors are working hard to diagnose and treat them.

And not sleepwalking.

"At present, it is only possible to distinguish the hypokalemia caused by alkalosis, and the cause of diabetes insipidus and diarrhea in patients will continue to be further differentiated and discussed."

Zhou Can handed over some very hard dry goods.

"He is the youngest and most promising doctor in our Department of Gastroenterology, and his diagnostic ability is rare. It was found out so quickly that the patient had hypokalemia caused by alkalosis, which was very serious. It also took me a lot of effort and a long time to get to this point. Or you young people's mental strength! ”

Zheng Hongtao couldn't help but sigh.

"You've won a prize! Since both of us have identified hypokalemia caused by alkalosis, the previous conclusion of the syndrome differentiation is basically correct. As long as the cause of alkalosis is identified, it is believed that breakthroughs can be made. ”

Zhou Can is full of enthusiasm for diagnosing and treating this ultra-difficult disease.

It's like attacking a city and plundering the land, breaking through a fortified city little by little.

Now that one of the acropolis of the enemy city has basically been broken, further investigation of the cause of the alkali poisoning is equivalent to tearing a hole in the defense of the main city.

This disease has found a breakthrough in treatment.

Huang Liang didn't look at the senior resident who was about to be promoted to the attending doctor, but he couldn't exert any strength in this level of diagnosis and treatment.

I just listened silently on the side.

"In alkalosis, hydrogen ions are transferred to the outside of the cell, causing a potential difference between the inside and outside of the cell, and potassium ions are passively transferred to the cell, which leads to hypokalemia. Is there any way to correct alkalosis? ”

Zhou Can's first thought was to treat first.

Some causes cannot be explored thoroughly, and treatment and investigation are commonly used clinical treatment methods by doctors.

It can also be called symptomatic treatment.

That is, after I find a problem, I can try to help the patient correct the problem first, and then see how the body reacts.

Many times, the body may just be a tiny part of the whole system that goes wrong. Correcting with medication or other means to restore the body's normal functioning is also a good idea.

Many chronic diseases are treated in much this way.

Patients need to take the medication for life.

Roughly speaking, the doctor knows that a small part of the patient's three major systems is wrong, but does not find the specific cause of the error. At this time, drugs are used to forcibly intervene to help them correct their mistakes, regardless of the cause of the error.

That's how amazing the human body is.

With the help of drugs, even if the cause of the error can never be found, it will not affect the effectiveness of the treatment.

For example, diabetics only need to inject insulin regularly.

The doctor knew that there was a problem with insulin secretion, but the specific reasons were strange, limited by the level of medicine and technology, and there was no way to break the casserole and ask the end.

Eventually, chronic diseases such as diabetes and high blood pressure almost invariably require lifelong medication.

"The patient has been treated with conventional intravenous potassium supplementation in other hospitals, but the patient's hypokalemia has not been corrected."

If you want to correct alkalosis, you have to start with the condition of diarrhea.

Zhou Can began to jump back to the problem of the patient's diarrhea.

At first, the patient had bloating, and it took more than a month for the patient to develop severe diarrhea.

"Director Zheng, can you do a small bowel perfusion test for the patient? It can help to identify the type and depth of the cause of diarrhea. ”

Zhou Can thought for a moment and gave a suggestion.

"Your diagnostic thinking is still to start with diarrhea?"

Zheng Hongtao's eyes lit up slightly.

When you can't find the answer to alkalosis, it is also a good idea to think differently and point to the disease itself.

"Isn't it necessary to tie the bell to the bell? By reversing the type and deep-seated cause of diarrhea, it may be possible to solve this puzzle and difficult case. Zhou Can smiled and nodded.

"Makes sense!"

Zheng Hongtao communicated with the patient's family on the spot, saying that the disease is difficult to diagnose, and suggested that the patient be hospitalized for further observation so that the doctor could find out the cause.

Doing a small bowel perfusion test needs to be scheduled, and it takes a longer time to observe the whole intestinal process.

The patient was ineffective in other hospitals, and naturally understood that the disease was difficult to treat.

Now that the two doctors have discussed it, it seems that some progress has been made. Seeing hope, the family readily agreed to be hospitalized.

Beds in the gastroenterology department are as tight as ever.

The patient was placed under observation and the small bowel perfusion test was done first, while waiting for a new bed to become available before arranging for hospitalization.

(End of chapter)