The Enhanced Doctor

Chapter 1238: Chapter 1238: Is It a Rare Disease?

(Thank you Benthime Bear for the monthly ticket encouragement)

Liu Banxia looked a bit worried as he walked into the internal medicine clinic with the test report.

"Are the test results out?" Wang Huan asked.

"The blood test results for the pregnant patient showed only a slightly elevated white blood cell count, everything else is normal. The patient with hypertension and hypokalemia did not show elevated blood aldosterone, and it is somewhat on the lower side. The blood sodium index is slightly high," Liu Banxia said.

Upon hearing this, Wang Huan quickly snatched the test report away.

Although hypokalemia can also cause symptoms of hypertension, when these two combine, the probability of primary aldosteronism is still high. But now? There’s an additional symptom of slightly elevated blood sodium, yet the blood aldosterone is normal.

"Are you saying the hypertension is a symptom caused by hypokalemia?" Wang Huan asked.

"It’s still hard to determine right now. You guys have more patient encounters. Do you have any new ideas?" Liu Banxia asked.

Wang Huan frowned, "The blood sodium is also a bit high, and this should catch our attention. Didn’t this show up during the first test?"

"No, during the first test, there was only hypokalemia," Xu Yino quickly replied.

"We can currently exclude primary aldosteronism. Elevated blood sodium is often more common in elderly patients," Wang Huan said.

"Because older individuals might have inadequacies in fluid intake, or it could be dehydration caused by certain conditions over a period. But your patient doesn’t have diabetes insipidus or diarrhea, right?"

"No, the diet is normal, and the patient is young," Xu Yino said.

"Interesting. This proves that the patient’s condition is still developing. What potassium supplement are you giving?" Wang Huan asked Liu Banxia.

"Potassium aspartate with magnesium, I think this kind of potassium supplementation is safer, and her blood potassium level isn’t too low," Liu Banxia said.

"Let’s do a urine sodium test," Wang Huan suggested.

"To me, the elevated sodium ion content is significant. It would be necessary to conduct a thyroid function test tomorrow morning. We went in circles and came back to the start again."

"Conduct a 24-hour urine sodium test to evaluate the patient’s urine volume situation. Extra attention is needed tonight as there might be new changes."

"Alright, that’s the plan for this patient. What about the pregnant patient? Any guidance?" Liu Banxia asked.

This is no joke; his attitude was quite sincere.

After all, he’s not an internal medicine doctor, and the patients he handles in internal medicine don’t even compare to a fraction of Wang Huan’s.

He may have diagnosed some conditions before, but those conditions had clear indications. Now, he’s faced with patients whose conditions are a bit obscure.

He wouldn’t dare to act confidently, thinking he’s got it all figured out, as it might delay the patient’s treatment.

"As for that patient, I don’t have much else to say; just observe and see if there are any other symptoms," Wang Huan said.

"What if it’s idiopathic and disappears after pregnancy ends? We can’t be sure of these things. Asking them to do a lumbar puncture now might be something they won’t agree to."

Liu Banxia nodded, as this aligned with his judgment.

"You two should pay more attention to these two patients tonight, especially the pregnant one, giving proper attention," Liu Banxia said.

The two nodded.

They understood that the patients they were handling had difficult aspects, but for now, observation was the priority.

Outside, Liu Banxia approached the pregnant patient’s bedside, "How are you feeling now?"

"Now I don’t feel like there’s anything wrong, not as tired as before," the patient replied.

"Currently, there’s no clear indication of your condition, and to minimize harm to you, we are observing for now," Liu Banxia said.

"We’ll check your condition again tomorrow morning to see if a lumbar puncture is necessary. You do have low-grade fever which is something we need to pay attention to."

"Doctor, can’t other tests be done? Will a lumbar puncture affect the baby inside?" the patient asked.

"Theoretically, it won’t," Liu Banxia said with a smile.

"The lumbar puncture is mainly to test your cerebrospinal fluid to see if there’s any intracranial infection. We will continue to monitor your body’s indicators to prevent any unexpected incidents."

"However, you shouldn’t drink too much water now, rehydration should be in moderation. Drinking too much can also affect the body’s electrolyte balance."

"I didn’t drink those, my husband did. He said he was thirsty. He drank two bottles of beverages and it didn’t help, so he went to buy more," the patient said.

Liu Banxia frowned, noticing that there were more than just two beverage bottles but also a bottle of mineral water. How thirsty does one have to be to drink so much?

At this point, the patient’s husband returned, still carrying a half-drunk bottle of beverage.

"Very thirsty?" Liu Banxia asked.

"Not exactly thirsty, just a bit of dryness in the throat. I also seemed to be in too much of a hurry earlier, sweated quite a bit." The patient’s husband replied.

"Do you have any other symptoms? Dizziness, headache, nasal congestion, or any discomfort at all?" Liu Banxia continued to ask.

"Other symptoms... not really, I guess? Just a bit of dry mouth, wanting to drink water, and sweating easily." The patient’s husband thought for a moment and said.

"I say you’re just lazy; we still have a gym membership at home. How many times have you gone since coming back from your business trip?" The patient’s wife spoke up.

"Have you had any business trips? Where have you been?" Liu Banxia asked hurriedly.

"I’ve been to India, well, it was during the New Year, and then the company had a holiday so I came back. It’s been some days, almost ten days." The patient’s husband said.

"You should get registered too, have some blood drawn and tested. This kind of thirst and excessive drinking isn’t common." Liu Banxia said.

"And as for India’s hygiene conditions, they’re just like that, right? It’s better to be safe, have a proper checkup."

Right now, he didn’t know whether this man’s condition was related to his wife’s, but he had to remain vigilant.

Travel history of this sort causing the spread of exotic diseases is quite possible. We’ve diagnosed someone with sleeping sickness before, can’t ignore it lightly.

With Liu Banxia’s words, the patient’s husband became scared, realizing that this severe thirst certainly wasn’t a good condition.

Complete blood count, blood biochemistry, blood culture, all necessary tests must be conducted. After a simple examination, the patient also had a slight fever.

This made Liu Banxia pay even more attention, at least there were overlapping symptoms between this couple.

"Teacher Liu, could it be a disease he brought back from outside?" Liu Yiqing asked.

"Can’t say yet. But for now, we can only observe; he doesn’t have other symptoms." Liu Banxia said.

"Ah... what’s happening today, why are they all such complex cases?" Liu Yiqing sighed.

"It only shows that our medical skills aren’t yet adequate, so we can’t quickly diagnose the conditions. Let’s see tomorrow, if we’re still unclear, we’ll need a multidisciplinary consultation." Liu Banxia said.

"Right now there’s really no way, symptoms exist but they’re not clear in presentation. The available tests we can conduct are few, rushing would provoke the patient’s displeasure."

Both of the young ladies nodded, they understood this point.

Not all patients are wealthy, wishing for more testing. Even if some patients don’t say much during early examinations, after multiple tests without a definitive diagnosis, emotions could arise.

Of course, you could ignore it and just prescribe tests, but that often increases tension in the doctor-patient relationship and easily breeds other issues.

Back in his office, Liu Banxia was pondering the situation of these two patients.

Currently, non-invasive tests that he could conduct have been thought over for a long time without reaching any conclusion.

The pregnant patient might be related to her husband’s situation. If her husband brought back some disease during his business trip, it would be difficult to investigate.

Because such diseases are certainly uncommon and have latent characteristics.

As for the second patient? Her current symptoms of hypertension and low blood potassium are uncertainly related.

They could be similar external manifestations of a single condition or due to low blood potassium causing hypertension. And now there’s a rise in serum sodium levels, making the symptom presentation even more confusing.

Is it also a rare disease?

Liu Banxia drew a question mark in his mind.

As it reached quitting time, Liu Banxia reviewed the conditions of these two patients, currently still stable, and observation was all that could be done.

"Teacher Liu, you can go home first, if there’s any development we will notify you." Xu Yino said.

"Ah... going home won’t really relax. If you have time, look into some rare disease books, see if there’re any matching these two patients’ conditions." Liu Banxia said.

"Teacher Liu, are you saying both these patients might have rare diseases?" Liu Yiqing asked curiously.

"Just a tendency towards that possibility." Liu Banxia said.

"In the past, even when encountering complex cases, we could at least have a general diagnostic direction. But today, both cases only warrant observation, to see if any new symptoms arise."

"By the way, ask that pregnant patient’s husband again, see if he’s been bitten by mosquitoes during his business trip. Many diseases are spread by mosquitoes, adequate prevention control measures should be taken."

"If his wife’s symptoms are related to him, that signifies a certain level of infectiousness, but doesn’t have the airborne transmission’s dangerousness or the same destructive power."

Both of the young ladies nodded in agreement, this did seem like a direction worth considering.

After dinner, let’s all get together with friends to search through books. If we can find corresponding symptoms, we won’t be grasping at straws like now.

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