Three o'clock in the afternoon.

After lunch in the small cafeteria, Zhao Sheng returned to the doctor's office and continued to be on duty.

With a cup of brewed coffee, Zhao Sheng just sat on the chair when Song Wei entered the office.

"There was an emergency, and a patient was transferred from the local hospital."

Song Wei looked at Youzai Youzai and Zhao Sheng, who was about to drink coffee, and said.

"I haven't taken a sip of my brewed coffee yet."

Zhao Sheng stood up a little helplessly, the emergency department is like a battlefield or even a fire ground, if there is a situation, it will be immediately called, and it cannot be delayed for a minute.

"Okay, let's go."

Zhao Sheng said to Song Wei.

After a while, Zhao Sheng and Song Wei came to the hall and saw that a middle-aged elder sister had been moved down from the ambulance, the middle-aged eldest sister was already lying on the transfer bed, her face was swollen, and she looked very bad, and a middle-aged uncle with glasses, who looked gentle and gentle, stood next to her, and it looked like her husband.

Zhao Sheng walked quickly to the side of the transfer bed, and at this time, he observed that this husband, that is, the middle-aged uncle with glasses, looked at his wife's eyes, which was a kind of hatred for iron and steel, and a look at a fool.

"What's the situation?"

Zhao Sheng asked Tan Bo, the emergency doctor who was accompanying the car.

"Renal insufficiency caused by acute hemoglobinuria, the local hospital said that it was kidney failure."

Tan Bo said.

"Huh? Renal failure due to acute hemoglobinuria? So powerful? ”

Zhao Sheng was shocked when he heard it.

This acute hemoglobinuria, to put it simply, is caused by the rupture of a large number of red blood cells due to various reasons, and the hemoglobin exceeds the binding capacity of plasma hemoglobin and the absorption capacity of the proximal tubule of the kidney.

The rupture of a large number of red blood cells in the human body is a rare occurrence, let alone kidney failure.

The only situation that Zhao Sheng can think of is that after a natural disaster, people are oppressed by heavy objects, which causes crushing syndrome.

Crush syndrome refers to a clinical syndrome characterized by limb swelling, necrosis, hyperkalemia, myoglobinuria, and acute kidney injury caused by prolonged compression of the muscle-rich parts of the limbs or trunk.

The core link of crush syndrome is rhabdomyolysis, which causes the leakage of muscle cell contents into extracellular fluid and blood circulation, resulting in a series of complications such as effective circulating blood volume reduction, electrolyte imbalance, acute renal failure, and multi-organ insufficiency.

"What caused it?"

After a pause, Zhao Sheng asked again.

"I heard that I went to do some kind of slapping therapy, but I don't know exactly what I wanted."

Tan Bo said.

"Okay, leave it to me."

Zhao Sheng nodded.

After a while, the middle-aged eldest sister was transferred to the indwelling ward.

Zhao Sheng looked at the eldest sister lying on the hospital bed, her whole face was already swollen at the moment, and her lower limbs were also very swollen, and she looked faintly translucent, which showed that there was a lot of exudate accumulated under the skin.

In this case, the kidney is not fully functional, which leads to the inability to complete the absorption, and the exudation accumulates under the skin.

Moreover, looking at the appearance of the eldest sister, her breathing is already a little short, which indicates that the lungs are also edema.

Song Wei quickly gave the eldest sister ECG monitoring, and Zhao Sheng saw that her body was 36.3 °C, her pulse was 80 times/min, her breath was 18 times/min, and her blood pressure was 180/90mmHg.

Well, there are no major problems with the basic vital signs, indicating that the kidney failure is progressive and has not progressed to the final level.

"When did it start, and why is it bad?"

Zhao Sheng routinely asked the eldest sister and said.

Hearing Zhao Sheng's words, the eldest sister lowered her head, as if she was very reluctant to speak, looking very regretful and ashamed.

"Say, the doctor asked you!"

The middle-aged uncle with glasses who was standing on the side, seeing that the eldest sister was silent, with a look of regret and shame, said distressed and angry.

"You say it's okay, why did she start bad?"

Zhao Sheng saw the couple like this, so he said to the uncle.

In the process of seeing a doctor, Zhao Sheng has seen too many family conflicts.

This is normal.

Middle-aged couples, old and young, high or low, 35 years old will be optimized, and then go to Didi to run takeaway stalls, and it is normal to have contradictions.

There is a saying that [middle-aged feelings are not as good as dogs, and when it comes to breaking up, they will break up], middle-aged couples, love is rancid, and their feelings have become clear and watery, coupled with aesthetic fatigue, a small wave of life can be broken up.

The married life of a middle-aged man can probably be described in such a sentence [the wife and children are calling me, pretending to be deaf and hiding], especially in the eyes of the wife and children, the husband and father, as soon as they go home, they are playing with their mobile phones with their feet crossed.

Even the child is puzzled, why does Dad pull so many times a day?

Some people ask if there is a pure friendship between men and women, and if there is, that is, middle-aged couples.

It can be said that [you and I have no chance, it all depends on the baby's entanglement].

"Doctor, she started bleeding three days ago, it was dark red at first, and then it turned soy sauce color, and then her face and legs were swollen, and she didn't breathe well."

The middle-aged glasses uncle thought about it and said.

Anger is anger, but illness still has to be seen.

Judging from his accurate description of the eldest sister's condition, he has always been concerned about the eldest sister's condition.

This is much better than some husbands who come to the hospital and don't know anything.

"Urea? What about the last two days? What about urea? ”

As soon as Zhao Sheng heard the crimson blood urea and soy sauce color urea, his face immediately became solemn.

This crimson urea can be said to be bleeding in many situations, such as urea tract injuries and other problems.

However, this urea is soy sauce color, that is, it is mainly hemoglobinuria, and a small part is myoglobin urea, because a large number of red blood cells in the body are destroyed, and a large amount of hemoglobin enters the blood, which is excreted through the kidneys to make the urea liquid soy sauce color.

"Yesterday morning until now, there is no urea."

The middle-aged glasses uncle saw Zhao Sheng's face suddenly become solemn, and said a little nervously.

"Have you had a check-up before you came?"

Zhao Sheng asked solemnly.

24-hour urea-free, which is the main criterion for the diagnosis of acute renal failure.

"I took a blood test, this is a list."

Seeing Zhao Sheng's serious face, the uncle hurriedly took out a report sheet from his bag.

Zhao Sheng took the report and took a closer look, it was a liver and kidney function examination, and it was good to say, look at the creatinine, good guy, 480μmol/L!

It is important to know that the creatinine of normal adult women is generally 70~106μmol/L.

480, that's five times faster!

24 hours without urea, creatinine suddenly rises, and the diagnosis of acute renal failure is no problem.

So the question is, what is the cause of such severe acute kidney failure?

(End of chapter)