Chapter 301: Chapter 0285: The Coin of Life
Lactic acidosis disrupts the acid-base balance in the body, further resulting in electrolyte disorder, leading to cardiac arrhythmia or cardiac arrest.
A 50% mortality rate, almost equal to the probability of coin flipping.
Wei Danian has an episode at least once a year, aning he has to flip the coin of life and death every year. Remarkably, he has managed to get the outco he wanted every ti over the years.
“Perform bedside blood filtration imdiately!”
Dr. An, the resident doctor in the ICU, made the decision promptly. This is the fastest thod to eliminate excessive lactic acid in the blood. At the sa ti, he continues to administer bicarbonate to the patient, carefully calculating the amount and rate of bicarbonate administration.
If the quantity of bicarbonate provided is too high or if it’s given too rapidly, it could trigger new problems and cause further electrolyte disorders. The quantity and rate must be just right; carelessness is not an option.
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The nurses start to perform arterial and venous punctures to connect the patient’s blood vessels to the hemofilter. Once successful, they turn on the blood pump, activate the replacent fluid and filtration device, and begin blood filtration.
“Will our anticoagulation cause major bleeding in your surgical site?” Dr. An inquires Dr. Jin’s opinion.
Dr. Jin states unequivocally: “No, there won’t be any problems. After our total joint arthroplasty under general anesthesia, the patients can imdiately receive subcutaneous injections of low-molecular-weight heparin to prevent deep vein thrombosis.”
“That’s good to hear!” Dr. An feels relieved. Once the lactic acid is depleted, the acid-base balance is restored, and the patient is sufficiently rehydrated. The effectiveness of these steps now needs to be observed.
Yang Ping is also waiting by the side. So young doctors and interns are asking him questions. He is well-known in the hospital and all the young doctors know who he is.
They are usually unable to interact closely with such a distinguished person, so now they have many questions to ask.
It seems that their three-pronged approach is working. Wei Danian’s blood pressure gradually increases, and his lactate levels are dropping as indicated by follow-up blood tests. The pH value of his blood is also slightly rising.
“We identified the issue very quickly. The chances of a successful recovery are pretty high.” Dr. An begins to see hope.
“Is there anything we need to pay attention to with the operated lower limb?” a nurse asks.
“Be careful when moving the patient. We need a dedicated personnel for slight traction. We will handle changing the dressing and pulling out the vacuum drain.” Dr. Jin guides the nurse on what they need to be careful of in nursing care.
Director Ouyang continually flips through examination records on the computer: “Make sure to communicate properly with the family. Record in the dical history that the family concealed information regarding the patient’s condition.”
Lactic acidosis is a rare complication of diabetes. Previously, tformin was used to lower blood sugar, but it could trigger lactic acidosis. tformin has since been phased out, making lactic acidosis less common.
“How did he develop lactic acidosis? This patient can’t possibly be using tformin. This dication has been phased out and discontinued. It wouldn’t be possible to buy it even if he wanted to. Therapeutic doses of tformin are not associated with lactic acidosis. There must be other reasons.”
Dr. Jin loves learning and thinking deeply. Naturally, he could not let go of such a case. As the patient slowly stabilizes, he aims to uncover the causes.
The patient experiences annual episodes of lactic acidosis. It is therefore feasible that he might experience it again during his hospital stay. It’s crucial to determine the cause of the condition as quickly as possible.
Lactic acid is a byproduct of glucose tabolism in the human body. There are three primary sources of energy in the human body: proteins, fats, and carbohydrates. Glucose, as a type of carbohydrate, is the main source of energy. It produces energy via two chanisms: aerobic oxidation and anaerobic ferntation.
Aerobic oxidation is the primary mode and is considered the main road. Anaerobic ferntation is a supplentary mode and is considered the side road. Whether glucose goes the main road or the side road, it eventually breaks down into carbon dioxide and water. Lactic acid is the illegitimate child when glucose takes the side road.
Regarding glucose undergoing anaerobic ferntation, which produces lactic acid, the most direct experience in the human body is post-excess exercise muscle soreness.
Especially in those who don’t regularly exercise, sudden increases in exercise volu result in a shortage of energy production from the aerobic decomposition of glucose. The body is forced to activate anaerobic tabolism, putting the pedal to the tal to urgently replenish energy.
Under such circumstances, glucose produces a byproduct – lactic acid, through anaerobic tabolism. When this excessive lactic acid can’t break down into carbon dioxide and water quickly enough, it accumulates in muscle tissue, stimulating nerve endings in the muscles, thereby causing muscle soreness.
Clinical doctors, especially surgeons, often give back their knowledge of basic dical science, such as biochemical knowledge related to carbohydrate decomposition, to their teachers.
“Under anaerobic conditions, glucose forms pyruvate through glycolysis, which then generates lactic acid through lactic acid ferntation; under aerobic conditions, glucose forms pyruvate through glycolysis, which then forms acetyl CoA in mitochondria. Acetyl CoA eventually forms carbon dioxide and water through the citric acid cycle; it can also eventually form carbon dioxide and water through the pentose phosphate pathway. Pyruvate needs the help of pyruvate dehydrogenase and a coenzy to enter the citric acid cycle. In cases of diabetes and starvation, there is a shortage of pyruvate dehydrogenase and the coenzy, so pyruvate cannot follow the typical pathway and has to take a detour, leading to an increase in blood lactate.”
Yang Ping explained this to Dr. Jin. Not just Old Jin, but also Dr. An from the ICU who found it headache-inducing. Despite knowing how to diagnose and treat these diseases, learning about these biochemical pathways and the citric acid cycle was a hassle during their student years. Relevance quickly faded after starting work, and they discarded this knowledge to avoid becoming overwheld.
Director Ouyang was even more confused and had no idea what they were talking about. Conversely, interns who had just graduated could understand so of it, but only just.
“I don’t know where the problem occurred that forced glucose to take a detour. If we want to find the cause, we should start from here.” Yang Ping wanted to explain in simpler terms but couldn’t manage it.
Using terms like ‘main route’ and ‘shortcut’, making the citric acid cycle sound interesting, the interns quickly made notes in their pamphlets.
Everyone knew that Dr. Yang was skilled in surgery and had instructed the Japanese on how to be human at an academic conference. They had not expected his knowledge of basic biochemistry to be so solid, and furthermore, he could even link it with clinical applications, which is why he was considered outstanding.
“Could it be a genetic disorder?” Dr. An guessed based on his experience.
“We can look into this aspect, but I’m afraid it’s not that simple. If it were a genetic disorder related to glucose tabolism deficiency, the other hospitals would have detected it.” Dr. Jin was more cautious.
Dr. Jin was very interested in these tricky and complicated cases. Last ti, they eased a patient’s years of pain from tal-allergic synovitis by removing screws. This ti, he was eager to collaborate with Yang Ping to explore the tough question.
To be rigorous in dicine, one cannot ignore any clue, but should follow objective evidence, reason strictly, and finally unveil the truth.
“Let’s create a group and bring in the doctors from the endocrinology departnt as well,” Dr. Jin suggested.
The suggestion was imdiately approved by Dr. An of ICU and Old Qin, the anesthesiologist. They were academically inclined. As doctors, to gain more recognition, they had to be more outstanding.
Director Ouyang didn’t want to get involved, as this was a matter for the young people. He didn’t have the passion or energy himself. He was already halfway to being white-haired; if he went on with them, he wouldn’t be able to keep the other half.
Dr. Jin imdiately created a group, nad “dical Detective Society”, and added everyone into it.
The case of Wei Danian beca the discussion target in this group. The fact that he suffers from lactic acidosis every year made the case interesting.
Finding the cause of a disease is a huge task that requires a lot of work and may not necessarily succeed in the end. Many diseases in the world are still undiagnosed each year; so are even diseases that have not been formally recognized in the world yet.
Wei Danian’s blood pressure increased, and his acid-base balance gradually corrected. The coin once again gave him the desired result. When Yang Ping exited the ICU, it was already evening. All of Wei Danian’s family mbers were waiting outside the ICU doorway in the family waiting area.
Dr. An went out to discuss his condition with them. Wei Danian’s father was wiping sweat while saying: “Doctor, thank you for your hard work. Our child has been like this since he was young, so we decided to stay near the hospital. We recently moved near your hospital. When we buy houses, we choose those that are nearest to the ergency departnt.”
It’s hard to imagine the feeling of enduring such a rescue operation every year. Not to ntion the financial burden, they also have to bear imnse ntal pressure. Every rescue is a pullback from the brink of death, and they never know when the next one will co.
“We dare not travel far, fearing that he may get sick on the road without any rescue conditions,” the mother said helplessly.
“If that is the case, why would you hide his condition? It’s so dangerous,” Dr. An criticized the parents for their ignorance.
“We thought, since he is in the hospital, if he suddenly falls ill, he could be resuscitated in ti. That’s why we didn’t dare ntion his condition, fearing you might delay the operation. Seeing the child crying in pain on the bed hurts our hearts,” the father replied with an awkward smile.
“Now his condition has slightly improved, his blood pressure has risen, but we need to continue observing him. We also want to find the cause of his illness, and you’ll need to sign the docunts for this,” Dr. An said, placing a stack of consent forms on the negotiation table.
“We have consulted big hospitals in Shanghai and Beijing, but no disease was diagnosed. Every dical consultation outside is a worriso ordeal. Imdiately after landing, we run to the hospital. We no longer hold hope for finding the cause of his illness; we just hope that he will be safe and well,” the father said as he flipped through the forms. Without even needing to look, they were familiar with the procedure and knew how to sign them even with their eyes closed.
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