Surgery Godfather-Chapter 300 - 0284: Admitted to ICU Every Year
Chapter 300: Chapter 0284: Admitted to ICU Every Year
According to several key lab results, it can be definitively diagnosed as lactic acid poisoning.
It’s peculiarly lactic acid poisoning. Neither the anesthesiologist, Director Ouyang, nor Dr. Jin understood why lactic acid poisoning occurred.
The anesthesiologist glanced at Yang Ping; his mild suggestion to “check for lactic acid” timely indicated the correct direction, otherwise, they would have undoubtedly wasted much time.
Without time to investigate the cause, the anesthesiologist immediately decided to treat the symptoms first—the patient’s life was the top priority.
“250ml of 5% sodium bicarbonate, to be administered through IV, examine urine output, measure central venous pressure!”
Correction of acidosis was the imperative task, then fluid resuscitation was necessary, and in severe situations, hemodialysis would be needed to filter out the lactic acid from the blood.
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250ml of 5% sodium bicarbonate was hanged, the anesthesiologist began to mentally calculate the amount of alkali to be supplemented using a formula.
The nurse began to measure central venous pressure; fluid supplementation needed to be adjusted according to central venous pressure.
The urine output from the start of the surgery to now was over six hundred milliliters, there was no water and sodium retention, so the alkali could be safely supplemented.
Director Ouyang had been in orthopedics for twenty years. If it weren’t for the training before the academic conference, he wouldn’t remember anything about the formulas for acid-base balance.
Not to mention the acid-base balance formulas, even how to rescue lactic acid poisoning cases would have completely slipped his mind.
The training before the academic conference was extremely beneficial, it strengthened his weakness in knowledge. Now, he could keep up with the anesthesiologist’s rhythm and understood the significance of these emergency measures.
Lactic acid poisoning has a mortality rate of 50%. When blood lactate exceeds 25mmol/l, it is rarely possible to achieve a successful rescue. Fortunately, it’s only currently at 8mmol/l, so it has not reached a point of certain death.
“Send him to the ICU!”
The patient’s vital signs have temporarily stabilized, and Director Ouyang made the decision.
“Quickly, move the bed.” The anesthesiologist followed beside the bed, the endotracheal tube had to be disconnected, so they could only squeeze the balloon to the ICU.
When things go wrong, they usually go wrong together. A good surgery, a muscle insertion fracture, an emergency call for a special guide caused a smoothly completed surgery to become a potentially critical situation, a sudden onset of lactic acid poisoning out of nowhere.
The equipment dealer manager was the most embarrassed at this time. He had booked the private rooms at the restaurant, but with this situation, he didn’t have the mood to eat. He stood aside, feeling inappropriate to leave, and could only wait in an awkward manner.
The manager was afraid that if anything happened to the patient, Director Ouyang would blame them. Of course, it was impossible to blame them in any case.
His fear was that Director Ouyang would stop using their equipment out of anger, even if it was just for a while, the loss would be significant.
As the patient was pushed out of the operating room, Dr. Jin shouted, “The family members of Wei Danian…”
A big family, two pairs of elderly people, and a middle-aged couple immediately surrounded them all.
Looking at Wei Danian lying on the bed, with a tube in his mouth, depending on a balloon for breathing.
The father of the patient, a fat middle-aged man, was shocked: “What happened? Doctor, why can’t he be alright all of a sudden?”
The grandmother felt dizzy and was about to fell. The father of the patient immediately supported the old woman.
“Danian, Danian!” The mother shook his shoulder violently, sobbing uncontrollably.
“He was perfectly healthy before, could eat and drink, what did you do during the surgery, turning him into this.” The grandmother pounded on the bed rail.
“Lactic acid poisoning, his condition is critical, he must be taken to ICU for rescue immediately, his life is in danger at any moment, do not hold on to the bed.” Dr. Jin tried to push the bed, but couldn’t move it as all the family members were holding onto the bed rails tightly.
“Lactic acid poisoning?”
The patient’s father was quite familiar with this term, he immediately regained his composure, and his face turned from pale to red: “Doctor, this condition occurs to him every year, he has to be admitted to the ICU at least once a year. It has been this way since he was a child. The doctors also said that it was lactic acid poisoning, but even after going to many hospitals, the cause of lactic acid poisoning was not found.”
When the whole family heard it was lactic acid poisoning, they stopped crying. Perhaps they had already become numb from experiencing so many times, or maybe they were just not so frightened because every time, fortunately, Wei Danian survived through rescuing.
“ICU, send him to ICU. Every time he has an attack, he is sent to ICU, sometimes he even needs dialysis.” The father was familiar with the process, dialysis probably meaning hemodialysis.
“We asked about the medical history several times, why didn’t you mention the lactic acid poisoning?” The doctor in charge of the bed was so angry that he clenched his teeth.
“Our child is afraid of pain. If we told you this, he was afraid of postponing surgery, so —” Wei Danian’s mother whispered.
“Confused, really confused, can the condition be concealed?” Dr. Jin harshly criticized, wishing he could kick them.
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Also, this young man is already twenty-five years old, and they still treat him like a child, cooing at him whenever there’s a sign of pain: “Good boy! Be obedient.”
The stretcher rushed to the ICU, going so fast, there were inevitably small bumps.
“Slow down, slow down, doctor, the child is in pain.” The grandparents were all worried, fearing that the bumps would hurt the child on the stretcher.
Rescuing a life is a race against time, are they seriously worried about the stretcher moving too fast and being bumpy?
Dr. Jin got angry: “Stop holding on, let go!”
After a few reprimands, the several pairs of hands that were more of a hindrance than a help finally let go.
The patient was finally taken to the ICU, the door kept the family members outside, they pounded on the door hard.
“How high is the lactate level?” The on-duty doctor asked.
“8mmol/l,” Dr. Jin sighed in relief.
That was not too bad, there was still hope. If it’s above 25mmol/l, recovery would basically be impossible.
Ultimately, lactate poisoning is metabolic acidosis. The acid-base balance in the human body is usually maintained, with a ph value of about 7.35 to 7.45. An increase or decrease in the body’s acid-base substances beyond the body’s regulatory capability can cause changes in the ph value. This is known as acid-base imbalance, which can be life-threatening.
The causes of acid-base imbalance can be due to respiratory factors or metabolic factors, an increase in lactic acid is caused by the latter.
“Put him on a ventilator, test his blood for routine examination, biochemistry, liver and kidney functions, blood lactate, blood gas analysis, prepare bedside hemofiltration…” The ICU doctors, who have seen many critically ill patients and are professionals in dealing with them, are more skilled than orthopedics and anesthesiologists in dealing with these conditions, and they are well equipped.
Even the use of a lung machine is considered everyday business to them, let alone something like bedside hemofiltration.
The ICU doctor, while listening to the heart and lungs, discussed the condition of the patient with Dr. Jin and the anesthesiologist.
After the handover was completed, the anesthesiologist, Old Qin, finally had the chance to ask Yang Ping, “How did you know it was lactate poisoning?”
“It was down to two options, this diabetes patient showed typical Kussmaul breathing, so of course I considered acidosis.”
Kussmaul breathing, also known as acidosis hyperpnea, involves a regular pattern of deep, rapid breathing which helps to get rid of more CO2 and has a compensatory effect on acidosis. It is a sign of the body’s self-compensatory capability.
“His breath also had a smell of ketone, so acidosis caused by substances like salicylic acid, phosphoric acid, and sulfuric acid can be ruled out. Insulin was still being pumped in, and at a rather fast speed too. For the blood sugar level to still rise up to ketoacidosis under such circumstances, the insulin must be fake. Hence, lactate poisoning is more likely.”
Just like that, with clear and rigorous logical deduction, from symptoms to pathophysiology, peeling back the layers to reveal the answer.
The super training program of the system allowed Yang Ping to link human anatomy, physiology, biochemistry, pathology, pathophysiology, and clinical symptoms with test results through logical relationships, continuously training and strengthening his clinical logical thinking abilities.
Through devilishly hard training, each session included a system screen for feedback and error correction. With repeated reinforcement, even in emergencies, Yang Ping can quickly reach a deeper understanding through established logical chains from symptoms.
Every appearance has deep underlying logic, you might not have discovered it yet, or medical science might not have discovered it yet.
Old Qin the anesthesiologist, carefully recalled Yang Ping’s words, there was nothing wrong and no flaws in them, they weren’t randomly made up. The process of deduction was as rational and evidence-based as solving high school problems.
Why could an orthopedic doctor have such strong diagnostic thinking abilities? Old Qin was somewhat puzzled.
“Why does this patient keep having lactate poisoning? Now, Metformin —— phenethylbiguanide has been phased out, this doesn’t make sense, we need to look for the cause.” Yang Ping instructed Dr. Jin, as the patient was from their team.
Diagnoses can be divided into symptom diagnosis, pathophysiologic diagnosis, pathological diagnosis, and etiological diagnosis.
Etiological diagnosis is the highest level, but unfortunately, many diseases cannot obtain an etiological diagnosis.
For examples, common diseases like hypertension and diabetes, their diagnoses are just symptom diagnoses, These are the lowest level of diagnosis in terms of diagnostic logic.
The lowest level of diagnosis implies that the cause is unknown, pathological anatomy and pathophysiology have not been fully studied, so only symptomatic treatment can be given.
Lactate poisoning can only be considered a pathophysiologic diagnosis, and treatment can only be initiated from a pathophysiological perspective.
This time it’s okay, but next time it may happen again, because the cause has not been found.
If you want to start etiological treatment, you must get an etiological diagnosis, and this is the hardest part.
“I’ll go back and check the literature.” Dr. Jin thought it was necessary.
However, whether Wei Danian could be saved or not was still an unknown.
