The Enhanced Doctor

Chapter 1236: Chapter 1236: Patient with Unexplained Convulsions

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"How’s that patient doing in internal medicine?"

Back downstairs, Liu Banxia asked.

"The gastric ulcer lesion is not small, but we’re doing conservative treatment first," Liu Yiqing said.

"That’s fine then, it’s all minor stuff. It’s definitely related to his usual eating habits too, just pay more attention later and it’ll be fine," Liu Banxia said casually.

"Thank you, Teacher Liu." Liu Yiqing suddenly dropped a line.

"What are you thanking me for?" Liu Banxia asked curiously.

"He came to borrow money from me, I really almost lent it to him. But I thought about it, if he really was short of money, lending him twenty or thirty thousand would still be doable," Liu Yiqing said.

"Then I heard the nurse say, it’s not that they don’t have money, they just want to spend mine. Teacher Liu, why do you think people can be so nasty?"

Liu Banxia chuckled. "You should be more ruthless, this is not just in the category of ’nasty’ anymore, this is bullshit. As long as you have a clear idea in your own mind, it’s fine. Even though he’s your only relative in this world, draw a clear line if you can."

As for Liu Yiqing’s brother and sister-in-law, he’d already given up any hope a long time ago.

Maybe in Liu Yiqing’s heart there was still a sliver of hope left, thinking that it was only after her sister-in-law came into the picture that her brother changed.

Anyway, Liu Banxia never thought that was the case. Being able to do things like this meant that her brother’s nature wasn’t any good either.

Because what her brother had done had pretty much, if not outright, broken through the moral bottom line.

"Director Liu, there’s a pregnant woman with sudden convulsions coming in soon, 24 weeks, current vital signs stable," Qi Wentai called out.

Liu Banxia nodded. "Let’s see what’s going on. Liu Yiqing, you take the case."

Liu Yiqing hurriedly ran to the entrance of the hall.

Pregnant patients must be given enough attention; even if they come in with a minor issue, you still have to be extra careful.

In less than ten minutes, the ambulance stopped at the entrance.

"Patient, 35 years old, 24 weeks pregnant. Vital signs stable, low-grade fever, had a tonic seizure," the paramedic pushing the patient said.

"Doctor, you have to check the baby. The year before last I fell and had a miscarriage," the patient said.

Liu Yiqing nodded. "Put her on the examination bed first, then we’ll do a detailed exam. Family members, don’t worry, go register first."

The patient’s husband nodded and rushed off to the registration desk.

"Any other medical history or symptoms?" Liu Yiqing asked the patient again.

"Nothing else, everything’s normal. I don’t know what happened today, I suddenly just couldn’t, I’d been fine all along," the patient said.

"Don’t worry, we’ll just run some tests," Liu Yiqing reassured her again.

Once they moved her to the examination bed, Liu Yiqing started the basic exam. She paid extra attention to the fetus in the abdomen, and watching from the side, Liu Banxia let out a long breath too.

The little baby in the belly was fine; at least that let everyone relax a bit.

"You can relax now, the baby is very calm, and the heartbeat is strong," Liu Yiqing said.

"Just now during the physical exam, aside from some low-grade fever and other symptoms, we didn’t find anything else. Next we’ll do blood routine, blood biochemistry, urinalysis, ECG, and then a brain CT to see what’s causing the convulsions."

"In the last few days, or say this recent period, have you had any other symptoms? Like nausea, abdominal pain, things like that?"

The patient thought for a moment, then shook her head. "No nausea or abdominal pain, but recently I’ve had occasional headaches, just these last two or three days."

"In that case, the brain CT is even more necessary. I’ll order the tests now, then we’ll do the corresponding exams. We can also see whether there’s a possibility of preterm labor," Liu Yiqing said.

"Doctor, how is she?" When Liu Yiqing came out, the patient’s husband asked anxiously.

"For now it doesn’t look like there’s any major problem, we’ll do some tests in a bit. Don’t panic yet. If you panic, who’s going to take care of her?" Liu Yiqing said.

The patient’s husband nodded and went to pay for his wife’s tests.

"It’s actually pretty nice—if something happens to me in the future, having a husband who cares this much would be enough. He’s so worried he’s sweating all over his forehead," Liu Yiqing said.

"Don’t think that far ahead yet. Someone who doesn’t even have a boyfriend is already worrying about stuff that far down the line," Liu Banxia dealt a merciless blow.

"I just don’t have time for now, once I have time I’ll find someone," Liu Yiqing said, a bit unconvinced.

But she also knew she was just being stubborn. Work was so busy now that she really didn’t even have time to go on blind dates.

"That patient’s surgery is done too?"

Just then he saw Zhang Xiao, and Liu Banxia called out.

"It was finished a long time ago. The surgery went very well, so you don’t need to worry about any other trouble." Zhang Xiao replied.

"That’s pretty good, otherwise getting the family to deal with things would be a huge hassle." Liu Banxia nodded with a smile.

Zhang Xiao also laughed; he’d been there at the time too. Back then he really thought the patient’s wife just wouldn’t sign anything and was going to make the patient shoulder everything himself.

"Teacher Liu, can you come over for a moment?" At this time, Xu Yino called out from not far away.

"What’s going on?" Liu Banxia asked after walking over.

"She came in with palpitations and muscle weakness. Recently she’s had a history of intense exercise and is currently dieting. Blood tests have ruled out rhabdomyolysis, but they show low serum potassium." Xu Yino said.

"What’s the potassium level?" Liu Banxia asked with a frown.

"2.8." Xu Yino said quickly.

"Dieting, huh, that can lead to low potassium. How about the rest of her physical indices?" Liu Banxia continued to ask.

"Everything else is normal, except her blood pressure is a bit high. We also did an ECG, which was negative." Xu Yino said.

"Let’s take a look at the patient. We don’t even know what exactly her dieting looks like." Liu Banxia said casually.

The truth is, there are many conditions that can cause hypokalemia, and right now none of them can be ruled out. But her muscle weakness symptoms should be related to the low potassium.

Fortunately it hasn’t progressed to severe hypokalemia yet, or it would be extremely dangerous.

"This is Director Liu from our emergency center." After they walked up to the patient, Xu Yino introduced him.

"When did you start dieting? Have you cut down a lot?" Liu Banxia asked.

"It’s been about three or four years. I’ve been controlling my weight all these years." The patient said, sounding a bit weak.

"This time I did cut back some, but not that much. And before, when I did intensive training, I did it like this too and nothing ever happened."

"Doctor Xu already explained things to you, right? Your current symptoms are due to hypokalemia, so our next job is to figure out what’s causing the hypokalemia." Liu Banxia said.

"Have you had any vomiting, diarrhea, or large amounts of urination recently? While dieting, have you taken any diuretics? And has your blood pressure always been like this?"

"None of that, and I haven’t taken any medication. I just work out and diet to lose weight." the patient said.

"In that case, we’ll first do a thyroid ultrasound later, and tomorrow morning we’ll draw blood to test your thyroid function." Liu Banxia said.

"Patients with changes in thyroid function often also present with low potassium, and the results are better on an empty stomach. Let’s get you admitted first; we need to supplement your potassium during this period."

"After potassium replacement, your muscle weakness will improve. If your potassium keeps dropping, there’s a risk of respiratory muscle paralysis."

"Even if you don’t really understand it, just hearing the name of that condition is scary, right? Respiratory muscle paralysis means you can’t breathe. Dangerous, isn’t it?"

He gave the patient quite a scare, and the girl who had come along with her also looked a bit stunned.

"I’m not trying to scare you into doing more tests. I want you to take this seriously enough. Hypokalemia is a very dangerous condition because it threatens the heart and other organs in the body." Liu Banxia continued.

"Once it reaches a certain degree, it becomes extremely dangerous. You need to be careful from now on—if you feel unwell, come to the hospital and get checked."

"Teacher Liu, are we admitting her to our surgical ward or transferring to internal medicine?" Xu Yino asked.

"Either is fine. Check how many beds internal medicine has free. If they don’t have many, we’ll put her in Second Department for now." Liu Banxia said.

Xu Yino nodded, hurriedly ordered the tests and started the admission procedures.

A potassium level of 2.8 isn’t low to a shocking extent; it doesn’t meet the criteria for ICU. Even if she were sent there, it would just be electrolyte adjustment and potassium supplementation.

Normally this patient should be admitted under internal medicine, but it depends on how many inpatients they have. Right now across the emergency center, Second Department’s ward is the least crowded, so they can accommodate her.

He actually wasn’t too worried about this patient; there are really many causes of hypokalemia. What he was worried about was that pregnant patient who had had convulsions, because convulsions are often related to intracranial lesions.

Another possible cause is high fever, but the patient only had a low-grade fever, not high enough to trigger convulsions.

He waited and waited, and that patient finished her CT as well. Liu Yiqing hurriedly pulled up the images.

After looking at them, Liu Banxia frowned. This was troublesome—the CT was negative.

If the convulsions weren’t caused by an organic brain lesion, there would be many other things to investigate next. The key problem is that the patient’s other symptoms aren’t very obvious, which makes the diagnostic work much more difficult.

Ding! Mission issued: Patient with seizures of unknown cause

Open mission: Patient is 24 weeks pregnant and has seizures of unknown cause, which requires the host’s heightened attention and further diagnostic work to identify the etiology. Mission reward: to be granted based on diagnostic outcome.

Beside him, Liu Yiqing nervously glanced at the silent Liu Banxia, because she also knew this patient’s cause wouldn’t be easy to pinpoint.

There’s a little baby in her belly, and if she has another convulsion, it could affect the baby.

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