radicalducati Chapter 674
Chapter 674
「674」
This time
The couple went straight to the emergency room.
It's a pity that Lin Feng doesn't go to work today.
That evening,
The child coughed suddenly, then his face turned cyanosis, and there were intermittent convulsions...
The husband and wife were so frightened that they rushed to the emergency room.
As a result, very coincidentally, Lin Feng happened to be working the night shift.
Coincidence collided together.
"Doctor Lin..."
"Sit... What disease? "
"It's like this..."
The husband and wife, you say a word, constantly add, and all the course of the disease and examination before and after are said in detail.
Lin Feng thought it was some kind of emergency, and came at night.
But as soon as I listened, it was okay, it was not an emergency, and I relaxed a lot.
"Have you brought all the checklists?"
"Brought ..."
The husband and wife are well-intentioned and get all the test results right.
Because there are very few patients on the night shift, Lin Feng also has enough time to check them one by one.
Soon, Lin Feng found a point.
Entry point!
Calcium ions!
"This blood calcium, the content of 3.61mmol/L, is too high..."
It is considered hypercalcemia.
According to the standard:
Mild: total calcium 2.75~3mmol/L;
Moderate: total calcium 3~3.5mmol/L;
Severe: total calcium> 3.5mmol/L;
This is considered severe hypercalcaemia.
Severe "hypercalcemia" can also lead to a series of serious clinical signs, called hypercalcemia, which can be life-threatening.
Its clinical symptoms are:
Vomiting: High blood calcium is a key factor in muscle excitation contraction coupling, while affecting action potential. Hypercalcemia can cause anorexia, weakened gastrointestinal peristalsis, nausea, vomiting, bloating, constipation, dysphagia, etc.
This corresponds to the main complaint of the child's condition - vomiting.
And then
It can also cause convulsions and cyanosis: high blood calcium can affect the electrical activity of neuronal cells, leading to fatigue, which occurs in the respiratory muscles, resulting in abnormal breathing, and lack of oxygen can cause cyanosis and convulsions.
This is in line with the main complaint of the child's condition - lack of oxygen, cyanosis, convulsions!!
In addition, hypercalcemia can also cause high blood pressure.
Lin Feng gave the child a blood pressure measurement.
Your baby's blood pressure is as high as 136/93mmHg,
Well, confirmed hypercalcemia.
In addition, hypercalcemia can also cause medullary sponge kidneys... Wait a minute......
See here,
Lin Feng felt that it was difficult for children to be hypercalcemia?
But
There are many masters in Harmony Hospital, hypercalcemia is so conspicuous, the indicators are clearly placed there, and they may not be able to hide it from the doctors who have seen it before.
So
The answer may not be that simple!
......
The condition continues to be analyzed...
Hypercalcemia, indicating that there is a lot of calcium...
And then
Lin Feng examined the child's skull and found that the development was not good.
And the previous doctor made a diagnosis of "skull depression".
So
There is reason to suspect that your baby's calcium absorption is not good enough.
"Have you ever taken AD?"
Because infants are in a period of rapid growth and development, their demand for vitamin D and calcium is relatively large.
Vitamins A and D are factors that promote calcium ion absorption.
If calcium is well absorbed, hypercalcemia will be reduced, but the calcium content in front of the eyes is too high, perhaps AD is not enough.
But
The answer is clearly not that simple.
The couple said: "This problem, the doctor of the gastroenterology department also said, we also noticed. Vitamin D, as well as vitamin AD, we all take as recommended by our child health care doctors, one tablet a day, absolutely no less..."
Lin Feng nodded.
This has already been expected.
The cause is indeed more cunning, hiding itself in layers of fog, and it will not be so easy to find.
......
But
Whatever the reason,
Hypercalcemia is undoubtedly true.
Vitamin AD, too, is indeed eaten.
so
Why hypercalcemia?
Further analysis:
The regulation of calcium ions can be summarized as "three hormones, three organs":
Parathyroid (PTH) (hormone)
Calcitonin (hormone)
1,25-Dihydroxyvitamin D3 (hormone)
Organs involved in regulation include bones
Intestinal
Kidneys
Abnormalities in any of the six links can lead to hypercalcemia.
Lin Feng looked at the patient's baby's blood checklist,
·「 Parathyroid (PTH)" is lowered.
Therefore, "PY-dependent hypercalcemia" is excluded and "non-PTH-dependent hypercalcemia" is considered.
In adults, the most common cause of non-PTH-dependent hypercalcemia is malignancy!
So
Lin Feng silently wrote in his heart:
To be investigated: malignant tumor!
Besides
There is no problem with the patient's baby's kidney function blood draw, and it is ruled out that the kidney function causes high calcium blood.
The previous doctor, apparently also considered the six links of calcium ion absorption, and did the corresponding examination, but did not find any special problems.
——Final summary: There is no problem with the six links of calcium ion absorption, except for malignant tumors to be ruled out.
It's a night shift, and there's obviously no way to do this kind of check.
To continue to wait for tomorrow daylight.
......
The above analysis did not find the answer.
Lin Feng thought about it and changed to another train of thought.
Just after physical examination, it was found that the child has developmental problems, and the height of the child does not meet the average level of the child's growth curve (50%), and only 5% is a low quantile.
Doctor in front, CT diagnosis: cranial fossa depression.
There is also an X-ray: local bone density reduction in the proximal end of the bilateral humerus, trabecular disorder, and irregular edges.
Other words
There must be something wrong with development.
There are also problems with the bones.
"Could it be a bone abnormality all over the body?"
And then
Lin Feng looked at the baby...
The more I look at it, the more awkward it feels...
Too small!
At this time,
A word flashed through Lin Feng's mind.
- "Rickets"!!
Rickets is familiar to the ears, and no parent will be unaware of this disease.
In the past, when everyone did not understand this knowledge, rickets was very common, known as "one of the four major diseases of pediatrics"!
However, with the popularization of the Internet, vitamin D supplementation in infants has become common knowledge among parents, so this disease has begun to become rare.
But
There is a question:
Is rickets generally caused by low calcium or vitamin D deficiency?
But children, obviously hypercalcemia!
So
Or back to the original problem - three hormones and three organs that regulate calcium ions, a total of 6 links, there is a problem.
Definitely something went wrong here!
But
At this time, Lin Feng was already enlightened.
Because "hypercalcemia" and "rickets" were put together, it gave him inspiration.
Bones grow!
In addition to thinking of "three hormones, three organs", an important enzyme - alkaline phosphatase (ALP) is also needed, which has a very important impact on the growth of bones!
It is used to promote bone growth.
Lin Feng looked at the baby's many biochemical checklists, and sure enough:
Alkaline phosphatase (ALP) – lower!
The average doctor will generally skip this data directly, because this data is rarely used and is secondary (for example, there is rickets in the baby (other factors are lacking), resulting in a large amount of alkaline phosphatase is of little use and is not used, resulting in elevated levels).
And now,
The baby in front of him is rickets, but it does not rise but falls.
There is only one reason: causal reversal, because alkaline phosphatase is reduced and other factors are abundant, resulting in rickets.
From this point in the derivation,
The answer is clear———— alkaline phosphatase is reduced!
The reason?
Why is it decreasing?
Logically speaking, alkaline phosphatase is secreted in large quantities in infancy.
However, there are exceptions.
When the patient is interfered with by anticoagulants, hypothyroidism, massive blood transfusion, cardiopulmonary bypass, pernicious anemia and Wilson's disease (severe liver failure) and so on... When the case, a decrease in alkaline phosphatase will occur.
But the baby clearly doesn't have these things.
Finally, it probably points to one answer - hereditary!
"Hereditary hypoalkaline phosphataseemia"!!
This is an extremely rare disease, very rare.
Lin Feng informed the couple of his guesses.
"Dr. Lin, do you mean that the cause of my baby's vomiting and convulsions has been found?"
"That's right, found it... But tomorrow we need to go for genetic testing to make further diagnoses. "
Although Lin Feng said so,
But the couple were already crying with joy.
That's great!
Finally found the cause!
During this time, they can be frightened!
The unknown is the most fearful.
And now, finally finding the reason, they don't panic.
......
The next day, sent for genetic testing...
The final result, as Lin Feng expected——
"Hereditary hypoalkaline phosphatasemia"!
..............................
Summary: vomiting, high blood pressure, convulsions, rickets... Wait, consider this...
。