However, early the next morning, Chen Cang was woken up by the phone.
"Professor Chen, a patient was transferred from the first hospital of Dongda. The main manifestation was wheezing, and then the extremities and around the mouth would become numb and even tetany. Why don''t you... Come and have a look?"
It was Wu Hui, the emergency doctor on duty, who didn''t really want to find Chen Cang, but the director of Neurology of the first hospital of Dongda and the director of Neurosurgery of the second provincial hospital are confused and don''t know the reason.
Chen Cang said, "well, I''ll be there right away!"
At this time, it was just dawn and there were not many pedestrians on the road.
When Chen Cang arrived at the hospital, he went directly to the intensive care unit.
Seeing Chen Cang coming, everyone nodded and avoided.
"Good morning, director Chen!"
"Good morning, director Chen!"
It''s late in winter. It''s actually more than six o''clock now.
Looking at the directors who had gathered together, Chen Cang nodded slightly to everyone.
"Good morning, directors. It''s hard." Chen Cang nodded his head and thanked him.
Everyone waved their hands one after another. Their eyebrows were tight and did not loosen.
"What is the patient''s condition?" Chen Cang asked.
Here, he Caiyun, director of the neurology department of the first hospital of Dongda, said: "this patient is an old patient of our department. He came back and forth four or five times last year, but he also had a rest for some time. Unexpectedly, after receiving the hospitalization a few days ago, the situation suddenly worsened!"
"The main thing is to pant. If you pant for a long time, the extremities and around the mouth will become numb, and even tetany will appear, and there are some mental abnormalities!
The main diagnosis is: hyperventilation syndrome, respiratory alkalosis combined with acid substitution, hysteria to be discharged. "
"But today, I suddenly found that my eyes have lost the sense of light, my pupils have widened to the side, and my reflection of light has disappeared!"
"We couldn''t find the reason, so we had to send it quickly!" he Caiyun said with lingering fear.
She came to the hospital at more than three in the morning.
The patient tossed about for more than two hours, but the situation became more and more serious.
My pupils are going to dilate, and there is no way in emergency and intensive care!
Here we hurried to the emergency department of the second provincial hospital.
Chen Cang nodded and looked at the patient carefully. The woman was only in her forties. He said to Wu Hui, "tell me about the patient''s examination results."
Wu Hui nodded.
"The patient''s examination results: the blood gas is carbon dioxide, the partial pressure is reduced, the bicarbonate is reduced, and the anion gap is increased."
The result of this examination is somewhat strange.
However, it is very consistent with the patient''s performance.
"Are there any primitive diseases?" Chen Cang asked.
He Caiyun shook his head: "no, this is an old patient. He was hospitalized several times. He checked everything he could, and he couldn''t find any problems!"
"Respiratory alkalosis combined with metabolic acidosis?" Chen Cang frowned directly. "It''s not common!"
He Caiyun and Du juanhong, two old directors, also nodded.
"Did you see it?" Chen Cang asked.
"Yes! But
After the ophthalmic consultation, the ophthalmologist checked the fundus and intraocular pressure, and found no problems!
Therefore, there is no way to diagnose for the time being.
However, it is not without harvest. At least, the common causes of sudden blindness such as glaucoma and uveitis are eliminated. "
This may be a blessing in misfortune.
"Is it optic neuritis or nmosd? But the sudden blindness of both eyes is more like vascular disease."
"Is it bilateral occipital infarction?"
"It shouldn''t be. If it''s occipital lobe infarction, it won''t cause the pupil''s light reflex to disappear?"
Du juanhong and he Caiyun also began to discuss.
The patient''s condition is really rare.
This kind of mydriasis due to respiratory alkalosis has hardly been heard!
However, the patient is a respiratory alkalosis!
There is little significance in diagnosis.
Push down according to this diagnosis
The only thing that''s hard to explain is the problem of Neurology.
When several people discussed.
Chen Cang also began to sort out his ideas.
There are many diseases of occipital cortical blindness, such as adrenoleukodystrophy and basilar artery tip. Although the pupillary reflex to light disappears, this will not happen basically!
Occipital lobe lesions can be basically excluded.
However, there are too many unexpected and unexplained cases in clinic.
So, hurry up and do an MRI!
Results the film showed that the patient''s condition was too normal!
All of a sudden, it really bothered everyone.
This does not seem to be a change in the nervous system.
Is it an optic neuropathy?
After some tossing, there was no result from 5 a.m. to 10 a.m.
Outside, the patient''s family members have been completely flustered!
Even conscious patients began to be afraid.
Two eyes can''t see anything, so it''s easy to worry.
At this time, the ophthalmologist suddenly said, "otherwise, give the hormone first!"
Compared with saving eyesight, we can''t take into account the side effects of hormones.
After all, there is nothing to do now.
Chen Cang has no way.
After all, the imaging data are normal, and the examination data is a respiratory alkalosis combined with metabolic acidosis in the later stage.
Chen Cang turned over and over and looked over all the medical records of the patient.
At this time, a voice suddenly sounded behind Chen Cang.
"Did you ask the patient''s occupation?"
in a word!
Chen Cang was stunned.
It seems to have been instructed!
Then the whole brain suddenly opened up.
However, what surprised him more was that the old man behind him was no one else!
It''s Mr. Zhong!
Chen Cang quickly got up and asked in surprise, "Mr. Zhong, are you here?"
The old man smiled and said, "I''m here to apply."
"But I''ll talk about it later."
"There''s another thing, why didn''t you ask the patient''s occupation at the time of diagnosis."
Chen Cang suddenly blushed!
For a long time, Chen Cangshi is so smooth that he ignores many details!
"Interrogation can''t be pulled down!"
"This patient, the diagnosis is correct, is still respiratory alkalosis, and is complicated with metabolic acidosis!"
"However, you have confused the order. The patient is not the so-called hyperventilation syndrome. His wheezing is not the cause, but the result!"
"The patient is hyperventilation caused by acid substitution, acid substitution is the cause, respiratory alkali is the fruit, and the essence is acidosis!"
"Think about it, why don''t you ask the patient''s occupation?"
Chen Cang was said by Mr. Zhong, and the answer in his mind is ready to come out!
Chen Cang is very proficient in poisoning!
It can lead to metabolic acidosis, respiratory alkalosis and toxic blindness
Obviously: methanol!
What is the patient''s occupation?
This is particularly important!
He looked at Mr. Zhong. Chen Cang blushed: "I''m sorry, I''m wrong!"
……
PS: thank the leader of the alliance "manshijue" for his 50000 reward. Thank you.
Today, according to the custom of my hometown, I went back to my hometown to burn paper at the grave. I''m sorry I''m late. I''ll make it up tomorrow.