Currently, Liu Banxia was desperately anxious. Even though he had administered sodium bicarbonate, it only delayed the problem, not cured it. The patient’s kidneys had issues, and if the exact cause of the illness was not found, his condition would only continue to worsen.
"Brother Wang, this patient is now showing early signs of kidney and liver failure. A catheter has been inserted. Should we transfer him to the ICU?" Liu Banxia asked Wang Huan, holding the test results.
"Not for now. Going into the ICU would an a new round of tests. Unlike post-operative patients, we still have a good chance of managing him here," Wang Huan responded after taking a look.
"What we need to do now is rehydrate him and adjust his electrolyte balance to prevent tabolic disorders and stop it from developing into uremia. His blood pressure is still a bit low, but it’s relatively stable, so we don’t need to worry about that for now."
"The main causes of acute renal failure are few: shock, trauma, infection, hemolysis, and poisoning. Could he have been unintentionally exposed to heavy tals?"
"Alright, I’ll run a heavy tal screening and a toxicology test. What about injecting Ulinastatin? I’ll also talk to his classmate again properly and see if he engaged in any strenuous physical exercise recently," Liu Banxia said.
"Now, I’m thinking the abdominal pain might have been an early sign of kidney failure. It’s just that the patient is in good physical condition, so the symptoms weren’t as severe. It might not be related to the Azithromycin injection."
Wang Huan nodded. "Yes, Ulinastatin can be effective for respiratory tract infections, bacterial pneumonia, pyelonephritis, bacterial septicemia, and ningitis. Let’s see how the patient responds after the injection."
Liu Banxia hurried back to the patient’s bedside and had the nurse administer the Ulinastatin.
"Young man, after he got back yesterday, did you guys do any strenuous exercise?" Liu Banxia asked the patient’s classmate.
The young man shook his head. "It was already quite late when he arrived. We just did a few simple things at ho and then went out to eat."
"Did you co into contact with any unusual substances? We also suspect your friend might be suffering from kidney failure due to heavy tal poisoning," Liu Banxia said.
"How is that possible? We’ve been together ever since he got back. I couldn’t have poisoned him! We ate and drank the sa things," the young man said hurriedly.
"You misunderstood. I’m not saying you poisoned him. He might have accidentally co into contact with heavy tals," Liu Banxia clarified.
"Even a small amount of certain heavy tals can remain in the body and affect one’s health. We have to wait for him to wake up and ask him if anything unusual happened while he was at his own ho."
After Ulinastatin was administered and his electrolyte balance adjusted, the patient’s condition finally improved sowhat. At least he was now awake and able to communicate normally.
Under Liu Banxia’s questioning, the patient’s account was the sa as what his classmate had said.
"What about before you ca here, when you were at your ho? Did you eat anything special or co into contact with any unusual substances there?" Liu Banxia continued to ask.
"Not really. I ate with my family at ho for breakfast and lunch. In the afternoon, I took a high-speed train to Binhai City. I had a bottle of cola at the train station, but nothing else," the patient said, shaking his head.
"Besides, if there was sothing wrong with the food at ho, my parents are older than ; they would surely have shown symptoms already. They would have contacted if that were the case."
Liu Banxia was also sowhat stumped. This young man is seriously ill, but what he’s saying makes sense. At the very least, it proves the Ulinastatin is working; his thinking is clear.
Just then, Zhou Qian brought over the latest blood and urine test results. Looking at the data on them, Liu Banxia sucked in a sharp breath.
The white blood cell count was alarmingly high, and the platelet count was also significantly elevated. The heavy tal screen was clear, but the toxicology screen? It indicated colchicine positive. Blood levels were at 108, and urine levels at 620.
Liu Banxia handed the latest test results to Wang Huan, then turned to the patient. "You... you didn’t try to commit suicide, did you? Just how much colchicine did you take?" he asked.
"Doctor, what’s that? I don’t eat narcissus, and I don’t eat autumn crocus either. Why would I commit suicide? I haven’t lived enough yet," the patient said with a bitter smile.
He genuinely didn’t understand what Liu Banxia was saying. If his body weren’t failing him right now, he’d definitely want to argue his case with Liu Banxia.
"Then, did you eat daylilies? Fresh daylilies?" Liu Banxia pressed.
Although the lab results had provided an answer, he still wanted to confirm it. Not all instrunt readings are completely accurate. Once a conclusion is drawn, it’s a process of working backward to verify.
The patient paused for a mont, then nodded. "I had them for lunch. Boiled and then served cold as a salad. I love that dish. Are you saying... I got sick from eating daylilies?"
DING! Hypotensive Syncope Patient task completed.
Received 200 Experience Points, 100 Diagnostics Skill Proficiency.
Task Rating: Perfect. Received an additional 200 Experience Points, 100 Diagnostics Skill Proficiency, and 7 Glory Points.
"Brother Wang, case solved! It’s colchicine poisoning. Should we transfer him to the ICU, or can we manage him here?" Liu Banxia asked.
"He needs to go to the ICU for continuous monitoring. He requires electrolyte correction, protein replenishnt, aggressive fluid administration, and acid suppression. We can’t adequately provide that here. Was that from the toxicology report?" Wang Huan asked.
"He ate a cold salad made with fresh daylilies at ho yesterday at noon. He has a good constitution, or perhaps his digestion was a bit slow, so it’s only fully manifesting now," Liu Banxia said.
"They must not have been cooked thoroughly when blanched; otherwise, this wouldn’t have happened. Since he loves them, he probably ate the entire dish himself. You should contact your parents. This is sothing they must be notified about," Liu Banxia added, looking at the patient.
"Am I... am I going to die?" the patient asked anxiously, now struggling to breathe.
"You likely won’t die, but you’re in for a rough ti. Fresh daylilies contain a chemical called colchicine, and eating too much of them can cause poisoning," Liu Banxia said.
"Moreover, there’s no specific antidote currently, and the toxins have already been absorbed by your body. Our only option is to administer large volus of fluids and continuously correct your electrolytes to support you until your body tabolizes and excretes all the colchicine."
"Your intake amount wasn’t extrely high; otherwise, you wouldn’t have even made it this long. However, it has still affected your body, causing damage to your kidneys and liver. You’ll need to stay in the ICU for a couple of days for comprehensive care."
"Doctor, th-then... how much will that cost?" his classmate asked.
"That’s why his parents really need to be notified. The money you two have definitely won’t be enough. However, we can start treatnt first; the paynt can be sorted out later," Liu Banxia said.
For the two of them, what other choice was there?
No matter how much they feared worrying their families, the call had to be made. Otherwise, there would be no way to cover the dical expenses.
"Sigh... I truly never imagined it would be fresh daylilies," Liu Banxia remarked after the patient was wheeled to the ICU.
"Normally, families that eat them often should be sowhat aware of the risks. But I’ve never eaten fresh daylilies myself, so I don’t even know what they taste like."
"You can try them when you have so free ti. Though, around here, you’d have to go to a morning market to find them. You could probably still find fresh ones for sale there," Wang Huan said with a smile.
"It’s a good thing you thought to run a toxicology screen; otherwise, we’d still be fumbling in the dark. He probably eats fresh daylilies often, so his body might have developed so tolerance."
"Teacher Liu, for similar patients in the future, should we always add a toxicology screen?" Xu Yino asked.
"That’s not set in stone; it still cos down to individual judgnt. If the symptoms align with poisoning, then adding one is fine. However, current rapid tests only cover common toxins and aren’t very comprehensive," Liu Banxia said.
"You all saw it today, didn’t you? What we learn from textbooks can only serve as a foundation for our judgnt. When these illnesses actually manifest in patients, there can be many variations."
"Normally, colchicine poisoning presents with symptoms like thirst, sore throat, abdominal pain, nausea, vomiting, high fever, and skin rashes. But our patient here? He only had nausea, abdominal pain, high fever, and a cough."
"And that cough was likely caused by the air conditioning while he was sleeping; it’s probably not even a symptom of eating the fresh daylilies."
"So, in the future, we all need to be more ticulous. I was lucky today. He was lucky too; his fainting spell due to the sudden drop in blood pressure is what alerted us. Any further delay, and we might have missed the optimal treatnt window."
"Speaking of which, if a patient with suicidal intent swallows a large quantity of colchicine pills, what’s the ergency treatnt? Hmm... Huang Bo, your hand shot up fast."
"Gastric lavage and enemas. These are the standard ergency asures for suicide by pill ingestion," Huang Bo replied.
Liu Banxia nodded. "That’s about right. However, for our patient, gastric lavage would likely be too late. Too much ti has passed; the colchicine has probably been mostly absorbed by now."
"Alright, everyone, be more careful in the future. I’m still learning too; this is the first ti I’ve encountered a patient like this. ticulousness is the foremost basic requirent for us doctors."
Taking it as praise, Huang Bo pumped his fist energetically and then got back to work.
"Nicely done. This bunch was a bit sluggish earlier from dealing with all those drunk patients, but now they’re all fired up. Still, today was a really close call, too close," Wang Huan remarked with a sigh.
"Tell about it... sigh..." Liu Banxia sighed as well.
What worried him now wasn’t the patient they just treated, but Qi Wentao. Qi Wentao’s attitude towards work was clearly off; he was being too perfunctory.
Even when he chatted with Zhou Shuwen yesterday, Zhou Shuwen had hinted that he could be bolder, to address the matter itself and not the person. But living in this society, especially in the unique environnt of a hospital, could he really do that without Zhou Shuwen’s kind of prestige?
He still had the sa concern: others might not say anything directly to him, but they might end up grumbling about Zhou Shuwen behind his back.
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