mtl008 Chapter 686
Chapter 686
Weakness in the limbs due to hypokalemia?
"I'm sorry!" Lin Feng shook his head.
Rabies, he is really powerless.
The puppy that bit the patient is supposed to carry the rabies virus.
The virus is transmitted through bites, or saliva carrying the virus may have invaded the body through scratched or bitten wounds.
Although not everyone will be bitten by a sick dog, the probability is only about 20%, but once the disease occurs, the mortality rate is 100%.
As for why rabies patients are afraid of water.
It is because after the rabies virus enters the human body, it will crawl all the way to the brain along the peripheral nerves, damaging the vagus nerve, glossopharyngeal nerve and hypoglossal nerve nucleus, which control the swallowing muscles and respiratory muscles.
Once damaged, it will lead to swallowing and respiratory muscle spasm, as long as the patient drinks water, or even just mentions drinking water or just hearing the sound of water, it may induce throat muscles and respiratory muscle spasm, resulting in a feeling of suffocation, so fear of water.
"Dr. Lin! Dr. Lam! The patient's father shouted unwillingly.
"Prepare yourselves! Once rabies attacks, the total course of the disease will not exceed 5 days, she has been ill for several days, I am afraid that time is running out! Lin Feng turned around and said in a low voice.
The patient's father picked up his wife, and the two returned to the consultation room and left with their daughter.
After returning to the office.
Lin Feng sat on the seat and was silent.
This is the emergency department.
I don't know how many patients I have to receive every day!
All of them are emergencies, and I don't know how many life and death partings have been seen!
But whenever I see the heartbroken look of the patient's family, my heart is still a little touched.
Intern Zhang Donglai did not understand, and the patient left in confusion.
After listening to all the conversations on the sidelines, he also had a guess in his heart, but he couldn't be sure.
Finally, he couldn't help but ask: "Dr. Lin, did the patient just have rabies?" "
"That's right." Lin Feng replied softly.
Hearing this answer, Zhang Donglai was also silent.
He was also well aware that a rabies attack meant a declaration of death.
Although he expected that he would see this situation with his own eyes, he did not expect that witnessing the death of the patient and announcing the death of the patient came so quickly, he was not mentally prepared, and his heart became extremely heavy at this time.
"Teacher, teacher!"
At this moment, Xiao Ru's voice came from outside.
After a while, I saw Xiao Ru and a middle-aged man holding a middle-aged woman and walking in.
After helping the female patient to sit down.
Xiao Ru then spoke: "Don't worry, this is my teacher, Dr. Lin Feng. With him, your wife will be fine! "
Lin Feng has adjusted his state at this moment.
The patient was helped in by Xiaoru, and Lin Feng naturally noticed that the patient's legs were weak and weak.
Then said softly: "Let's talk about the specific situation, when did this situation appear?" "
Hearsay.
The patient's old public horse began to speak.
Just a day ago.
The patient had limb weakness after exercise, and at first thought that it was just normal fatigue caused by excessive exercise, but when the limbs in the back became more and more weak, and even the chopsticks could not get up, this came to the hospital.
"Your hearts are really big enough, you came to the hospital like this!" Lin Feng couldn't help but say.
"Yes, yes, I don't pay enough attention." The patient's husband said immediately.
The patient said, "I thought I was tired, but I didn't expect it to be sick." "
At this time, the patient's voice is as small as a mosquito fly, and the exaggeration can be said to be like a gossamer.
Lin Feng immediately said: "Your symptoms are very similar to myasthenia gravis, this is a very serious condition, it will die!" Check it out before you know for sure, though! "
It would be fatal to hear.
The patient and his old public horse tensed up.
Lin Feng continued to ask, "Was this situation before?" "
"No, for the first time!" The patient answered.
"Did you have any strenuous exercise the other day? Muscle pain? Lin Feng asked again.
"The muscles seem to hurt a little, but it's either very painful or weak." The patient said thoughtfully.
"First draw blood to see the level of muscle enzymes, myoglobin, etc., and then go for a CT to check if there is any problem in the head, whether there is a cerebral hemorrhage or brain tumor or the like." Lin Feng said to the patient while opening the list.
Although the patient's condition is very similar to myasthenia gravis, it cannot be ruled out whether it is due to the brain that caused the patient's condition, and the situation in the brain cannot be missed.
Hearing this, the patient and her husband were very cooperative, and then her husband said worriedly: "Doctor, I am also worried that my wife has had a stroke, and my second uncle had a stroke before, and his hands and feet suddenly couldn't move!" "
Lin Feng immediately said: "It doesn't have to be a stroke, it's just a routine investigation." Does your wife have high blood pressure, diabetes, coronary heart disease? "
"The blood pressure seemed to be a little high before, and there was no treatment. Nothing else! The patient said himself.
Lin Feng nodded.
The patient was then brought to the hospital bed and a simple examination was performed.
Except for some limb weakness (muscle strength about 3-4 grades), there were no other significant abnormalities.
Blood was drawn.
Then he was ready to push her to do CT, before Lin Feng asked again: "Have you eaten any special food in the past few days, have you vomited, stomach discomfort and so on?" "
"No, it's all eaten at home, there are no special circumstances." This time it was the patient's husband who answered.
Lin Feng nodded.
Asking these questions is naturally his consideration, if you eat some special food, resulting in food poisoning, it will also cause limb weakness and even paralysis, and food poisoning will also be accompanied by vomiting and other symptoms, since there is no vomiting, it means that it will hardly be food poisoning.
The patient was sent to the CT room and soon the results were in.
Everything works fine.
There were no cerebral hemorrhages, no cerebral infarctions, and no brain tumors.
Is it really myasthenia gravis?
Lin Feng was also uncertain, or he had to wait for the patient's blood draw results.
It didn't take long to return to the consultation room.
Xiaoru came back with the results of the blood test.
Lin Feng glanced at it.
There is no problem with creatine kinase and myoglobin levels, so myasthenia gravis can be ruled out.
Blood potassium concentration 2.4mmol/L
Normal is in the range of 3.5-5.5.
The patient's condition is already severe hyponatremia.
Lin Feng immediately said: "Your blood potassium concentration is too low, it belongs to severe hyponatremia, and your limb weakness is likely to be because of this." "
Hearing this, the patient's husband asked happily: "Doctor, have you found the cause?" Is that enough to treat my wife? "
"Sort of. Well... It can also be said that it is not yet. Lin Feng said after a moment of silence.
The patient and her husband listened in the clouds.
"Doctor, what do you mean by that?" The patient's husband immediately asked, his face a little nervous.
Lin Feng continued: "What is the reason why patients have such low blood potassium? It's not clear yet, so I said that I didn't find it, and if I didn't find it, the same problem will occur in the future. "
Hearing this, the patient's husband nodded thoughtfully.
Without waiting for the two to speak.
Lin Feng continued to ask the patient, "How is your appetite during this time?" Eat too much? "
Normally, the most common cause of hypokalemia is insufficient supplementation, long-term fasting, partial eating, anorexia, etc., resulting in insufficient potassium intake, resulting in low potassium.
Hearsay.
Patient: "No, I eat very well, enough, I won't be able to lose weight and eat less..."
Su Jun groaned.
Since eating is not reduced, it is not low potassium caused by insufficient supplementation.
That being the case, there are other reasons.
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