Lactic acidosis causes the body's acid-base balance to become imbalanced, causing electrolyte ion disorders and leading to arrhythmia or cardiac arrest.
A 50% mortality rate is about the same probability as flipping a coin.
Wei Danian has at least one attack every year, which means that he has to toss a coin between life and death every year in his life. For so many years, he actually got the side he wanted every time.
"Perform point-of-care hemofiltration!"
Dr. An in the ICU made a prompt decision. This was the fastest way to remove excess lactic acid from the blood. At the same time, he had to continue to replenish alkali to the patient and accurately calculate the amount and speed of alkali replenishment.
If the amount of alkali supplementation is too large or the speed is too fast, it will cause new problems and cause new electrolyte ion disorders. This level must be measured appropriately and cannot be done casually.
The nurse began to puncture the arteries and veins to connect the patient to the vascular circuit of the hemofiltration machine. After the connection was successful, the blood pump was started, the replacement fluid and filtration device were activated, and the blood filtration began.
"Our anticoagulation won't cause heavy bleeding at your surgical site, right?" Dr. An asked Dr. Jin for his opinion.
Dr. Jin is very sure: "No, no problem. Our patients after general anesthesia and artificial joint replacement can be injected subcutaneously with low molecular weight heparin calcium for anticoagulation immediately after surgery to prevent deep vein thrombosis."
"That's good!" Dr. An was relieved. He cleared the lactic acid, replenished alkali and corrected the acid, replenished fluids to expand the volume, and it will be observed whether it works.
Yang Ping has also been waiting nearby. Several young doctors and interns are asking him some questions. He is very famous in the hospital, and all the young doctors know him.
Normally, I just watch people from a distance, but now I get to know them up close. Naturally, the eager-to-learn doctor has many questions to ask.
The three-plate ax seemed to be effective. Wei Danian's blood pressure slowly increased, the blood lactate value for reexamination began to decrease, and the blood PH value also gradually increased.
"The discovery is timely, and the chance of successful rescue is relatively high." Dr. An saw hope.
"What should I pay attention to when performing surgery on the lower limbs?" the nurse asked.
"Be careful when moving. You need someone to pull you slightly. We will do dressing changes and extubation for negative pressure drainage." Dr. Jin gave guidance on the precautions for nursing.
Director Ouyang kept flipping through the disease history records on the computer: "Communicate well with the family members. The family members conceal the medical history and record it clearly in the disease history records."
Lactic acidosis is a rare complication of diabetes. In the past, phenformin (Jiangtangling) was used to lower blood sugar, but this drug could induce lactic acidosis. Later, this antidiabetic drug was eliminated, and lactic acidosis became rare.
"How did he get lactic acidosis? Could it be that this patient took Jiangsu Ling? It's impossible. All banned drugs are eliminated and you can't even buy them if you want. The therapeutic dose of metformin will not cause lactic acidosis. There must be other reasons."
Dr. Jin loves to learn and think very much. When encountering such a case, he will naturally not let it go. The patient is gradually stabilizing, and he has to find out the reason.
This patient has an attack every year, and it is possible that he will have another attack at some time while he is in the hospital. Finding the cause as soon as possible is the right way.
Lactic acid is an intermediate product of grape metabolism in the human body. The human body has three major nutrients: protein, fat, and sugar. Glucose is a sugar and is the main energy supply substance for the human body. It provides energy in two ways, one is aerobic oxidation
, one is anaerobic glycolysis.
Aerobic oxidation is the main method, the main road; anaerobic glycolysis is the supplementary method, the small road. Whether you take the main road or take the small road, it will eventually be decomposed into carbon dioxide and water. Lactic acid is the illegitimate child of glucose that takes the small road.
The anaerobic glycolysis of glucose through the pathway produces lactic acid, and the most intuitive experience of the human body is muscle soreness after excessive exercise.
Especially for those who do not exercise regularly, if they suddenly increase the amount of exercise, the energy supply generated by the aerobic decomposition of glucose in the human body will be short, and they have to start anaerobic metabolism, turn on the horsepower, and replenish energy in an emergency.
At this time, glucose produces an intermediate product---lactic acid under anaerobic metabolism. A large amount of lactic acid has no time to decompose into carbon dioxide and water, accumulates in the muscle tissue, stimulates the nerve endings in the muscle, and causes muscle soreness.
Clinicians, especially surgeons, have mostly returned some basic medical knowledge, such as biochemical knowledge about carbohydrate decomposition, to their teachers.
“Under anaerobic conditions, glucose undergoes glycolysis to generate pyruvate, which is then fermented to lactic acid; under aerobic conditions, glucose undergoes glycolysis to generate pyruvate, and pyruvate generates acetyl-CoA in the mitochondria, and acetyl-CoA is then
After the tricarboxylic acid cycle, carbon dioxide and water are finally generated; it can also be generated through the pentose phosphate pathway, and carbon dioxide and water are finally generated. Pyruvate enters the tricarboxylic acid cycle and needs the help of pyruvate dehydrogenase and coenzymes to catalyze it. When diabetes and diabetes
When you are hungry, pyruvate dehydrogenase and coenzymes are insufficient, so pyruvate cannot take the main road and can only take small paths, so the lactic acid in the blood increases."
Yang Ping analyzed it for Dr. Jin. Not to mention Lao Jin, Dr. An from the ICU also felt a headache after listening to it. Although he usually knew how to diagnose and treat these diseases, these biochemical pathways and the tricarboxylic acid cycle were the same when he was a student.
Troublesome things will not be used clinically after work, so naturally throw them all away, otherwise the top of the head will be bald.
Director Ouyang was even more confused. He didn't know what Yang Ping was talking about. On the contrary, the newly graduated intern doctor could understand a little bit, but only just.
"I don't know which link went wrong, forcing glucose to take a side road. If you want to find the reason, start here." Yang Ping wanted to be more informal, but he couldn't.
Take the big road, take the small road. The decomposition of glucose was so interesting that the intern quickly took out the booklet and took notes.
Everyone knows that Dr. Yang does beautiful surgeries and teaches Japanese people how to behave at academic conferences. Unexpectedly, he can learn these basic biochemical knowledge so well. The key is to combine it with clinical application. A good person is a good person.
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"It should be a genetic disease?" Dr. An guessed based on experience.
"You can check this aspect, but I'm afraid it's not that simple. In so many hospitals, genetic diseases related to glucose metabolism defects would have been detected long ago." Dr. Jin is more cautious.
Dr. Jin is very interested in these difficult and complicated diseases. The last time he had metal-reactive joint synovitis, he took out the screws and the pain that had troubled the patient for several years was relieved. This time he is eager to try again and wants to cooperate with Yang Ping.
Explore the puzzle.
Medicine must be rigorous, and it must be like this. No clues will be missed, everything should be based on objective evidence, rigorous reasoning and demonstration, and finally the truth will be revealed.
"Let's create a group and include endocrinologists." Dr. Jin suggested.
The proposal was immediately approved by ICU Dr. An and anesthetist Lao Qin. They are quite academically motivated. As doctors, the more awesome they are, the stronger their sense of presence will be.
Director Ouyang didn't want to get involved. This was all a matter for young people. He didn't have the passion and energy, and half of his hair was already white. If he continued with them, he wouldn't be able to keep the other half.
Dr. Jin immediately created a group, named it: Medical Detective Agency, and pulled everyone into it.
Wei Danian's case has become the target of discussion in this group. Lactic acidosis occurs every year. The case itself is very interesting.
Finding the cause of the disease is a huge project that requires a lot of work and may not be successful in the end. There are many diseases in the world that are unclearly diagnosed every year, and some of them are diseases that have not yet been diagnosed in the world.
Wei Danian's blood pressure increased, the acid-base balance gradually corrected, and the coin was once again thrown on the side he wanted. It was already evening when Yang Ping came out of the ICU, and all Wei Danian's family members were waiting in the family waiting area outside the ICU gate. p>
Dr. An came out to talk to them about their condition. Wei Danian's father wiped his sweat and said, "Doctor, thank you for your hard work. My child has been like this since he was a child. That's why we have always lived near the hospital. This time we moved to a place near your hospital. We have to buy a house."
Choose the place closest to the emergency department."
It’s hard to imagine how it feels to be rescued like this once a year. Not to mention the financial cost, it also requires tremendous psychological pressure. Every time I am rescued from the gate of hell, I don’t know when the next time will be.
"We don't dare to travel far for fear of getting sick on the road and there are no conditions for rescue." The mother said helplessly.
"In this case, why are you still hiding your condition? How dangerous it is." Dr. An blamed the ignorant parents.
"We also thought that if he suddenly fell ill in the hospital, he could be rescued, so we didn't dare to mention his condition. We were afraid that you would delay the operation and see the child lying on the bed screaming, which would make us feel uncomfortable." The father smiled awkwardly.
"Now the condition has improved a little and the blood pressure has gone up. Further observation is needed. We also need to find ways to find the cause. All of these require your signature." Dr. An placed a stack of signed documents on the negotiation table.
"We went to the major hospitals in the capital city and the imperial capital, but no disease was found. Every time we went out to see a doctor, we were always worried. We ran to the hospital as soon as we got off the plane. We didn't expect to find out the cause of the disease, we just hoped he was safe.
”
My father flipped through these signed documents. They were very familiar without looking at them. He knew how to sign them even with his eyes closed.