The bustle outside the hospital has nothing to do with Sun Lien. When Vice President Liu walked out of the rescue hall, Xu Yourong called over. A calm Xu Yourong's tone was a little nervous, she didn't say anything specific, just urged Sun Lien to come to her office immediately.

Although he was a little worried about Dean Liu, it was normal to stay away in this situation. Sun Lien looked back and saw that the crowd of onlookers outside seemed to be in a stable mood, so he climbed down the stairs to the sixth floor.

Xu Yourong does not have his own office. Her office, like other neurosurgeons, was crammed into a less spacious room. The interior is divided into single rooms with acrylic partitions similar to those common in the clerical departments of third-rate private enterprises. Unlike private enterprises, the light gray tables inside are quite wide - basically each table is more than one meter two long. Without exception, it is full of all kinds of books and styles of ancient and rare 4:3 ratio 17-inch LCD computer screens.

Xu Yourong sat in front of the computer, looking at a document. His face was full of anxiety.

"What's the matter?" Today is the day of surgery in the neurosurgery department of the Fourth Central Hospital, and most of the surgeons are working on the operating table with the patient's brain or nervous system, so there are quite a lot of empty spaces around. Sun Lien dragged a stool with his hand, sat down next to Xu Yourong and asked, "It's inconvenient to say it on the phone?"

Xu Yourong turned his head and said to Sun Lien, "Just now...... A call came to my phone. The person on the other end of the line said Dr. Bruce had asked him to help pass the word and let me look at the literature......" she gestured to the computer screen, "The University of Maryland Hospital study does not recommend vitamin C acidification in urine for patients with acute methamphetamine poisoning. If renal insufficiency is present, acidification of urine may cause myoglobin to crystallize in the renal tubules, worsening kidney damage. ”

This treatment method is not groundless, Sun Lien quickly understood the key point of this treatment method - the protection of organs, especially the liver and kidneys, has a positive significance for poisoned patients. As the largest detoxification organ and the most important excretory organ in the human body, whether the liver and kidneys can work smoothly will largely determine whether the poisoned patient can survive.

There is no clear answer to the question of why the urine is green, but at least the urine proves that Gao Yan's body is still working hard to get everything to work.

The principle of acidified urine treatment belongs to organic chemistry. Sun Lien didn't learn very well, but he finally understood the mechanism of this process. Methamphetamine has a -NH2 bond attached directly to the benzene ring, and this hydrogen molecule can be ionized. Acidifying urine can reduce ionization and try to preserve its molecular properties. And such methamphetamine is not easily reabsorbed into the bloodstream by the renal tubules.

The essence of vitamin C injection to acidify urine is to reduce the re-absorption of methamphetamine by the kidneys, so as to achieve the purpose of increasing excretion. What really increases urine output is mannitol and the full eight litres of fluid that will be replenished in a day.

Although it is uncertain exactly when and how much methamphetamine was used. But what is certain is that during this time, his kidneys have been working at a high load. This means that his kidneys are likely to be impaired.

"Arrange for kidney function tests, and liver function tests are also checked. "The most important thing now is to immediately identify the extent of Gao Yan's physical injury. "Vitamin C was stopped first, and mannitol and liquid supplementation continued. ”

"It's been arranged. Xu Yourong's movements were faster than Sun Lien's, and she pointed to the electronic report on the screen, "The report that just came out after I called you, the blood creatinine increased to 596 μmol/L, and the blood β2-microglobulin increased to 3.1 mg/L. ”

Sun Lien's face suddenly darkened, and he leaned back in his chair and sighed, "Big landmines!"

The normal reference value of serum creatinine is generally between 62~115μmol/L. Suddenly jumped to 596μmol/L, then the kidneys were basically shouting, "Lao Tzu is not doing it!". The increase in blood β2-microglobulin indicates the specific "strike" of the renal structure, the proximal convoluted tubule reabsorption function.

Gao Yan is not a kidney dysfunction, it is an acute kidney impairment. In words that everyone can understand, he developed symptoms of acute kidney failure.

"Let's adjust the treatment plan. Sun Lien scratched his head, "Acute kidney damage, he must no longer be expected to be able to rely on his own body function to recover." In this case, he had to get on the dialysis machine. ”

Xu Yourong had a sad face, "I also need to control the amount of fluid recharge, which must be controlled within two liters per day." ”

Sun Lien nodded and said, "You call the ICU and ask them to stop the medicine quickly." After a slight pause, Sun Lien asked, "If acidifying urine doesn't work, what about alkalizing urine?"

"You ......" Xu Yourong looked at the monster with an expression, and stopped talking. After glancing at Sun Lien a few times, she suddenly laughed again. "I can only blame you for being so unusual these days, I really think of you as my senior doctor. She tapped her hand on the table and said, "The kidney damage has already formed, and it won't help you to alkalize your urine now." Moreover, the symptoms that had developed suggested that his kidney damage was not caused by the production of crystals after acidifying the urine, but by acute methamphetamine poisoning. ”

Sun Lien nodded with some embarrassment. Since he was able to see the status bar, Sun Lien's mentality has indeed undergone some subtle changes. He used to be able to follow the orders of his senior doctors for treatment, but he began to gradually build up his self-confidence. Based on what he has learned in the past, he can guide the way of thinking of senior doctors, and even directly deal with patients. But at the end of the day, he's still just a recent undergraduate medical student. He lacks experience and knowledge.

The current Sun Lien is like a sensitive humanoid comprehensive physical examination machine. He can be very keen to find the patient's symptoms, but he can't give a suitable treatment and treatment plan - the first few patients were properly handled, on the one hand, because Liu Tangchun and others were on the side, and on the other hand, because their symptoms were relatively simple, they were all considered normal treatment of the emergency department.

But the situation in Gao Yan is different. His kidney damage should technically be taken care of by the nephrology department. In the case of the Fourth Central Hospital, the attending doctor still has to continue to be responsible for treatment until the referral is confirmed. This has become a comprehensive test of Sun Lien's knowledge.

It would be nice to have a nephrology doctor on the team. For the first time, Sun Lien felt that his small team had shortcomings that urgently needed to be filled.

"Go on dialysis. Sun Lien smiled embarrassedly, "Dialysis can filter out toxins and waste products in the blood, and it should also be effective against methamphetamine." ”

Xu Yourong asked after a while, "Do you want to add naloxone?"

Naloxone is a very special drug. Its effect on the human body is mainly reflected in opioid receptors, and it is a commonly used opioid receptor antagonist in clinical practice. It has an extremely high affinity for opioid receptor nerves and is able to block the receptor effect of opioids on the receptor in the human body.

To put it in layman's terms, naloxone is like a group of strong men who like to cut in line. They easily cross the brain-blood barrier and are able to reach their maximum concentration within minutes of intravenous injection. By virtue of its strength and affinity for μ receptors, naloxone is able to compete with various opioids. and reverse the effects of opioids and relieve the symptoms of opioid overdose.

The problem is that while methamphetamine also acts on opioid receptors, it's not an opioid — it's not even a sedative or pain reliever. With naloxone, the strong men held the receptors firmly, which also hindered further treatment.

Increasing the blood supply to the kidneys is an important solution to improve the condition of the kidneys. But this regimen requires the use of dopamine, which is "held" by naloxone. Causes the dopamine injected into tadine to lose its effect.

But if naloxone is not used, while increasing the blood supply to the kidneys may save his kidneys, it also means that methamphetamine will continue to work in his brain, stimulating and poisoning the cranial nerves. If the time is too long and the scope of irreversible damage is too large, he will be directly brain dead.

Regardless of the kidneys, kidney failure can lead to cascading multi-organ failure. Gao Yan will die.

Regardless of the kidneys, prolonged stimulation will completely damage his brain. Gao Yan will still die.

Sun Lien was stunned.

After a long silence, he whispered, "Let's take naloxone." ”

Kidney failure, while scary, may cause multi-organ failure. But after all, there is a dialysis machine in front of it. It is no more threatening than brain damage. Even if kidney failure occurs, lifelong dialysis or a kidney transplant can at least sustain a high level of life. And brain damage...... There is no such thing as a brain transplant.

Sun Lien stood up and said to Xu Yourong, "I'll go talk to Gao Yan's family, and you can contact the doctor in the nephrology department." Ask them to come over for a consultation and see if there is anything that can be done about the kidney damage. ”

The waiting hall at the entrance of the ICU is not an area for patients. It serves the families of patients who are outside the ICU and feel uneasy.

Gao Yan's parents gradually recovered from their initial anger. The son is twenty-one years old this year and left them to live in Ningyuan. And without parental supervision, children can sometimes cause incredible messes – sometimes even to their own lives.

Gao Yan's parents sat in the waiting hall of the ICU for a minute, and they took Gao Yan's mobile phone handed over by the doctor and called every contact in the phone book. Many people chose to hang up directly after hearing the voice of the old couple, and some people who had a relationship with their son mentioned the bad habits of Gao Yan in the branches.

The old couple was completely dumbfounded. They are overwhelmed by despair and worry, anger and panic, hugging their heads and crying.

.。 m.