The Enhanced Doctor

Chapter 1237: Chapter 1237: Hypertension and Hypokalemia

(Thank you to Yangzhong, Lu Hongzhang, Bentime Bear, and Dashi Tou for the encouragement with the monthly ticket)

"Brother Wang, let’s research this and see what exactly is going on with my patient. Well, let’s handle both patients together." Liu Banxia arrived at the internal medicine consultation room.

"The first patient is a pregnant woman, 24 weeks pregnant, experiencing unexplained seizures. A brain CT was done, negative, with low-grade fever and headaches. The second patient is experiencing muscle weakness due to low blood potassium, currently receiving potassium supplementation, and has been scheduled for a thyroid ultrasound."

"My thought for the second patient is to check thyroid function tomorrow, fasting tests should be more accurate."

"What is the blood potassium level of the second patient?" Wang Huan asked.

"2.8, and recently has been dieting to lose weight, and has also undergone intense physical exercise." Liu Banxia said.

"Alright, it’s not too much off. Intense exercise combined with dieting could result in some degree of potassium loss, supplement and see." Wang Huan said.

"Oh, right, the second patient also has symptoms of hypertension." Liu Banxia slapped his forehead.

"I really am confused, what have I been thinking about all day, muddled and unclear. Only focusing on the first patient, could it be aldosteronism?"

"It’s very possible, the combination of hypertension and low blood potassium, the probability for aldosteronism is still quite high." Wang Huan said with a smile.

"Xu Yino, conduct another blood test and urine test for the patient, check the aldosterone levels." Liu Banxia said.

"Alright, Teacher Liu, can you and Teacher Wang discuss the situation of the first patient a bit later? I’d like to learn." Xu Yino quickly said.

Liu Banxia nodded, "Quickly go and come back."

Xu Yino dashed out.

"Ah... today I feel a bit muddled, no idea if it’s because I’m only thinking about going home after work." Liu Banxia sighed.

"Liu Yiqing, take note, Director Liu is absent-minded today, he forgot the classic condition represented by the combination of hypertension and low blood potassium, it’s really rare." Wang Huan said with a laugh.

"It may not necessarily be this condition, but it needs to be ruled out first. However, there are many causes for low blood potassium, and if you haven’t noticed, the patient’s hypertension might only be slightly elevated."

"Perhaps I was a bit too eager, focusing solely on the thyroid. Luckily, it’s still timely and won’t delay matters." Liu Banxia said.

Aldosteronism, in full, is primary aldosteronism syndrome, caused by excessive production of aldosterone from the adrenal cortex. The main and most obvious symptoms are hypertension and hypokalemia.

Today’s patient situation is actually quite simple; intense exercise and dieting wouldn’t result in such significant potassium ion loss.

So, the indicator for aldosteronism is quite clear, just check the aldosterone levels in the blood and urine tests to confirm or rule it out.

Soon, Xu Yino returned, sweating heavily.

"Rest assured, we didn’t secretly research." Liu Banxia said.

"Teacher Liu, I asked the lab, and they agreed to expedite the processing." Xu Yino said.

"See? Our Doctor Xu still has significant influence." Liu Banxia said seriously.

"Teacher Liu, isn’t it because of the patient’s low blood potassium? What if there’s another change, suddenly transitioning to severe hypokalemia?" Xu Yino wasn’t swayed.

"Alright, alright, let’s study the first patient a bit further. The blood test results aren’t out yet?" Wang Huan asked.

"Not yet, but they should be soon." Liu Banxia said.

"The urgency is because she’s pregnant. Without high fever symptoms, is there a tendency towards intracranial issues?"

"Additionally, this patient has a history of miscarriage, which complicates other checks. The husband and wife both care deeply for the child, any thoughts?"

"Temporarily, I don’t have any ideas, given the conditions. But I also lean towards intracranial issues, if there are no organic lesions, there might be an infection." Wang Huan said.

"Let’s analyze, the patient has low-grade fever, which can rule out high fever-caused reasons. Other common causes include epilepsy, tetanus, rabies, or calcium deficiency."

"Let’s wait for the blood test results, check the calcium ion levels. If they’re normal too, the remaining test is a lumbar puncture."

"This isn’t a matter of want or not, either continue observation to see if other symptoms arise, or wait for the blood test results."

"It could also be due to endocrine disruption caused by pregnancy, metabolism changes, possibly leading to calcium deficiency? That’s also possible."

Liu Banxia nodded, "Let’s go wait for news outside, we’ll see what’s happening once the blood test results are out. How are you two doing? Learned anything?"

Upon hearing his question, Liu Yiqing obediently raised her hand.

"Speak, why so serious?" Liu Banxia said.

"Consider the patient’s situation comprehensively." Liu Yiqing said.

"Just that one sentence?" Liu Banxia asked with a smile.

"Yes, that’s my biggest takeaway." Liu Yiqing said matter-of-factly.

Liu Banxia nodded, "That is correct, but it’s mostly about preparing a prognosis. Try to consider issues from the patient’s perspective as much as possible."

"Take for example our pregnant patient, with a history of miscarriage, she would definitely be more concerned about the fetus. So, some of our inspections, be they invasive or non-invasive, she might resist."

"So we need to pay attention to this. It’s currently giving me a headache. Anyway, you were the one who admitted the patient, so if a lumbar puncture is really needed, you should discuss it with the patient."

Liu Yiqing was dumbfounded. Why do I have to do it?

Wang Huan watched cheerfully. Anyway, this group is always lively.

Outside, the blood test results for the patient had come out. Apart from a slightly elevated white blood cell count, there were no other problems.

This makes it quite troublesome. The most concerning situation is this.

"Teacher Liu, you’re not really going to make me talk to the patient about doing a lumbar puncture, right? Is there no other way?" Liu Yiqing asked pitifully.

"I’m thinking too. You all think about it, is there any other way?" Liu Banxia said with a frown.

The two exchanged a glance and shook their heads together.

Because the patient’s condition is indeed moving towards intracranial infection.

Intracranial infection can affect the central nervous system, and the patient also has a headache. Even if the patient describes it as a mild headache, it’s still a symptom.

"Actually, another possibility is regarding the immune system. Diseases like this often present with rashes or pimples on the body. You two go check the patient."

After thinking for a while, Liu Banxia said.

The two nodded and quickly went to find the patient.

Liu Banxia was feeling a bit overwhelmed.

Actually, the simplest and most direct examination is lumbar puncture. An examination of the spinal fluid is very clear regarding intracranial infection.

But now the patient seems completely normal, even if you mention it, the patient would probably refuse.

This is where the difficulty lies now; working with the patient’s mindset might be challenging.

Many pregnant patients have been admitted before, and in their minds, the child inside is always the priority.

Now there’s nothing else to do but wait slowly. And looking at the current situation, my off-duty time will be late again today.

It’s inevitable, it’s part of the daily routine in the emergency center. Patient illness can’t be scheduled, it happens whenever it happens.

"Teacher Liu, no rashes or pimples were found. We asked further, and the patient currently feels no discomfort."

After waiting for a while, the two girls came back.

"What should we do? You two give me an opinion."

Liu Banxia said.

"Anyway, Teacher Liu, I’m going to check if my patient’s blood test results are out." Xu Yino dropped a sentence and ran away.

"She ran off, so it’s just you left. What do you think we should do?" Liu Banxia asked.

"Well... should we perform an immune system screening or should we observe for a while and then do the lumbar puncture?" Liu Yiqing asked tentatively.

"Let’s observe first. If it’s an immune system condition, she should also have other symptoms. Looking at it now, it seems fine, almost enough to rule it out."

Liu Yiqing nodded and visibly breathed a sigh of relief.

Facing pregnant patients puts a lot of pressure on her, not to mention that lumbar puncture is an invasive examination.

It’s not that Liu Banxia is focused on getting off work on time and going home. In many cases, observing the progression of the patient’s symptoms can be helpful for diagnosis.

Otherwise, some examinations would be very blind, wasting the patient’s energy and money. If too many tests are done, it’s difficult to conduct them again next time.

"Doctor, what’s wrong with my wife?" At this moment, the patient’s husband also came over.

"There are no clear indicators at the moment, so our idea is to observe for a while and see if there are recurrent convulsions." Liu Banxia said.

"Our inclination is towards some intracranial conditions, but to be precise, only a lumbar puncture can determine that. So we choose to observe first, and we’ll delay invasive tests like that."

The patient’s husband nodded, understanding that Liu Banxia and the others were considering his wife’s welfare.

"Teacher Liu, my patient’s blood test results are out. The blood aldosterone levels didn’t increase, but the blood sodium is a bit high." Xu Yino came running over at this time.

Listening to Xu Yino’s report, Liu Banxia felt even more overwhelmed. It turns out it’s not primary aldosteronism, so tracing it will be really difficult. Do we have to wait until tomorrow to check thyroid function?

"How are the thyroid ultrasound results?" Liu Banxia asked.

"Negative." Xu Yino said.

Ping! Task issued: Hypertension, hypokalemia patient

Open task: Patient visits with symptoms of hypertension, hypokalemia, test results show blood aldosterone levels did not increase, the host needs to conduct further tests to determine the cause. Task rewards: issued based on diagnostic results.

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