Looking at the latest test results, Liu Banxia frowned.
The stool test was normal, with no signs of occult blood. The urine test showed potassium levels were not elevated, and the kidney ultrasound results were negative.
This left him sowhat puzzled, because he thought Liu Lu's hypokalemia was most likely related to the kidneys, which is the main cause of potassium loss in adults.
"Xu Yino, check if Doctor Xu from cardiology and Doctor Wang from internal dicine are available. If they are, call them over for a consultation," said Liu Banxia.
Xu Yino nodded and hurriedly went to get them.
"Banxia, what's the situation?" The first to arrive was Wang Huan.
"Take a look. There's so mitral valve prolapse. But there's high blood urea nitrogen, hypernatremia, and hypokalemia. The urine test is normal, the stool test is normal, and the kidney ultrasound is normal," said Liu Banxia, handing over the relevant reports.
"Could it be due to short-term severe dehydration? Does the patient have acute diarrhea?" Wang Huan asked after reviewing the reports.
Liu Banxia shook his head. "She even attended a yoga class today. She usually consus a high-protein diet and has a habit of drinking alcohol and beverages."
"But that still shouldn't result in this. In my judgnt, it should be caused by rapid dehydration," Wang Huan said, furrowing his eyebrows.
"I thought so too, but the patient's physical presentation doesn't quite match that. Do you suppose it could be related to certain dications? Such as so weight loss pills, or perhaps drugs?" Liu Banxia asked quietly.
Weight loss pills could be discussed openly, but drugs couldn't be ntioned so casually. After all, dostic controls in this area were quite strict, different from the more chaotic environnts found in so other countries.
"You called over to determine if the mitral valve prolapse is primary, right?" Xu Guosheng, who had just arrived, spoke up.
"Xu Yino briefed you? Then I won't waste ti explaining. Given the current situation, can you make a diagnosis?" asked Liu Banxia.
Xu Guosheng shook his head. "A diagnosis of mitral valve prolapse must exclude secondary causes. Furthermore, the current degree of disease progression in the patient is not severe. I would lean towards a secondary cause."
"Keep investigating. There must be other reasons causing this series of symptoms in the patient. Knowing you, I guess you must have questioned the patient in detail?"
Liu Banxia gave a wry smile and nodded. "Other than consuming more protein than usual, drinking alcohol, drinking beverages, and exercising, there's nothing else."
"Next, I plan to ask the patient if she has been taking diet pills. It might also be so kind of unregulated dication that has caused the current situation."
After all, the market for weight loss products was currently quite chaotic, and many of them contained banned substances. Given the patient's condition and symptoms, he leaned towards this possibility.
Xu Guosheng's suggestion also aligned with his deduction: the mitral valve prolapse was likely due to a secondary cause. Therefore, the mitral valve prolapse itself had beco a secondary concern; the main priority was to identify the underlying reason.
"Liu Lu, have your urination and bowel movents been normal lately?" Liu Banxia asked, having arrived at the patient's bed.
"Yes, they've been normal. I haven't noticed anything unusual," said Liu Lu.
"Have you taken any dication or weight loss products? We speculate that the electrolyte imbalance in your body could be due to the influence of a certain drug," said Liu Banxia.
"While you do exercise, we believe that even if your activity level is higher than an average person's, it shouldn't cause the current situation."
"Usually, such situations occur among fitness fanatics, typically in their beginner phase. Yoga is relatively mild. Even if you exercise intensely, you wouldn't push yourself to such extre levels, would you?"
Liu Lu shook her head. "I haven't taken any dication. I'm already thin; I don't need to lose weight. Dr. Liu, does this an my illness cannot be cured?"
"It's not that it can't be treated. We can manage the symptoms. If the levels are high, we help tabolize it; if low, we replenish it," Liu Banxia explained.
"But those are just temporary solutions, treating the symptoms, not the root cause. If we don't find the underlying cause, it could potentially affect your mitral valve. If the prolapse worsens in the future, we might have to resort to valve replacent."
"How about this: we'll start by making so adjustnts for you, and then we'll continue our investigation. Perhaps we've missed sothing; I'll review the reports a few more tis. Don't worry too much for now."
Liu Lu nodded with a worried expression, causing Liu Banxia to frown again. That feeling that Liu Lu was hiding sothing resurfaced, but it wasn't appropriate to press her further right now.
"Yanzi, do you know Liu Lu well?" Liu Banxia asked, calling over Wang Xiaoyan.
"Reasonably well, I guess. What's up?" replied Wang Xiaoyan.
"What about her lifestyle habits? I feel like she's not telling the whole truth. Have you ever seen her take any unusual dication, or anything related to weight loss?" Liu Banxia asked.
"Hmm... I haven't seen that. We've eaten together a few tis, and her appetite seed quite good," Wang Xiaoyan explained.
"We were all quite envious of her; she eats whatever she wants and doesn't gain weight. If I had her body, I could stuff myself like Qiaoqiao does."
"You know how people might gain a few pounds over the holidays? It's never an issue for her. Actually, she does yoga and exercises mostly to relieve boredom and pass the ti. Usually, she doesn't have much else to do, so she just goes out to have fun with others. You know... you get what I an?"
After speaking, Wang Xiaoyan winked.
"Er... I get it, sort of. But shouldn't she be more low-key under normal circumstances?" Liu Banxia asked curiously.
"Oh my, Comrade Old Liu, you're not keeping up with the tis. It's not like she's necessarily being a howrecker, destroying soone's family. It's more like everyone's just playing along, no strings attached, nobody holding anyone back," Wang Xiaoyan said helplessly.
"What? Things have escalated to this level now?" Liu Banxia got even more curious.
Wang Xiaoyan rolled her eyes. "You should focus on treating patients, not let your mind wander. What? You want to join in? Should I give Qiaoqiao a call for you?"
"Oh my gosh, do you think I have the leisure for that? I'm just trying to identify potential causes by looking into her lifestyle," Liu Banxia said with a wry smile.
"We consulted, and based on her current symptoms, it seems she might have an electrolyte imbalance caused by dehydration. However, she hasn't had severe diarrhea, and her eating and drinking habits are normal."
"So I need to determine whether she's been taking any kind of weight loss pills to maintain her figure, as many of them contain banned substances."
"I doubt it. She probably doesn't take weight loss dication. When she ca to my place, she wasn't as skinny as she is now, but she wasn't fat either," Wang Xiaoyan countered.
"Qiaoqiao and I tried so for a while; it made us vomit and have diarrhea, so we threw them away within a week. Most diet pills either contain laxatives or so form of appetite suppressant, right? She doesn't have any of those symptoms."
Liu Banxia nodded. "So, that leaves one last possibility. Has she ever shown symptoms similar to drug use? For example, sotis seeming dazed, other tis extrely fatigued, and other tis very agitated or excited?"
"Um... I don't think so either. But I can't guarantee it. She's always acted normal around us," Wang Xiaoyan hesitated.
She hadn't expected the issue to beco so serious. Even though she and Qiaoqiao liked to have fun, they would never touch such substances.
"Let's think it over more thoroughly then. First, let's adjust her electrolyte balance to manage her current symptoms," Liu Banxia nodded.
He suspected that perhaps the patient's hesitation was due to so issues in her personal life, which gave him the mistaken impression that she was hiding sothing.
Now that this aspect was sowhat clarified, and external interferences like diet pills or casual drug use seed less likely, it ant there was likely a genuine, still unidentified, dical cause.
What if it was hyperthyroidism? That could also cause weight loss and increased appetite. But the patient's neck showed no abnormalities; it was clear even without a physical examination.
If her emaciation were this severe and still related to hyperthyroidism, there would surely be other external manifestations.
In that case, it might be an absorption problem in the digestive system. Could it also be that so level of ntal stress was affecting the normal functioning of her digestive system?
"Brother Wang, do you think the patient's gastrointestinal dysfunction might have caused abnormal absorption in her digestive system?" Liu Banxia went to Wang Huan's office.
"Are you planning to examine her gastrointestinal tract? Gastroscopy, colonoscopy? Or a barium al, or a CT scan?" Wang Huan asked with a smile.
"An enteroscopy is very uncomfortable; most people can't tolerate it. Unless she's willing to have a capsule endoscopy, which takes longer but could be worth a try."
"But if there's a problem with the patient's gastrointestinal absorption, it would typically manifest in her bowel movents and flatulence. The patient said her bowel movents were normal, right?"
Liu Banxia nodded. "But I can't think of any other possibilities right now. She hasn't had diarrhea, and she hasn't taken any dication. So what could have caused these current test results?"
"Sigh... I was just mulling it over too. It's quite a headache," Wang Huan said.
"We're adjusting her electrolytes now, aren't we? Let's observe the situation after that. In her current condition, too many gastrointestinal exams could easily cause her discomfort."
"During this ti, we can also observe the patient more closely for any other symptoms. Often, it's these seemingly isolated symptoms that make a diagnosis more difficult."
"Especially when it involves the digestive system; so many organs are involved, and the endocrine system must also be considered. If we were to conduct a comprehensive screening for all of these, it would be a massive undertaking."
Liu Banxia grimaced. He couldn't agree more. It wasn't just the gastrointestinal tract and esophagus, but also the liver, spleen, gallbladder, pancreas, thyroid, and so on—all potentially related. Essentially, it would be like giving the patient a full-body scan.
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